COLUMBIA  LIBRARIES  OFFSITE 

HEALTH  SCIENCES  STANDARD 


HX00077658 


RECAP 


illANS/ 


OIT    TJ.1E 


I   6NT3       NATIONAL 
V     CONFERENC 


UBL1CS 


.  •    :,.,.. 


Sft'jR     r»     '!<>     i  i  ,     '\'--i\ 


ffiAl      I  u    IJIBTRIBUTED 

it^DiCK    THE 
UK    PAN    AMERICAN   UNION 

;  ■  ;  'i\    OIRKCTOR-GENERAL 
-SilfrvOTON,  D.  C. 


O-A-V- 


UoAA^t 


n^co^^      /=^OL/w^\oUvM    C-^Ym-    MLaa-*_«_ 


* 


\  1 


Columbia  (Hnitiersfftp 

intljeCttpofiftrttigDrk 

THE  LIBRARIES 


Jfflebtcal  Htfcrarp 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/transactionsoffiOOpana 


SPECIAL  NOTE. 

Mr.  John  Barrett,  the  Director  General  of 
the  Pan  American  Union,  an  institution  devoted 
to  the  development  of  comity  and  commerce 
among  the  American  nations,  and  which  acts  in- 
cidentally as  the  office  of  the  International  Sani- 
tary Bureau,  presents  his  compliments  to  the 
readers  of  this  volume,  and,  in  expressing  the 
hope  that  they  will  enjoy  a  perusal  of  its  contents, 
desires  to  state  that  if  they  care  for  further  in- 
formation concerning  the  Latin-American  Re- 
publics they  can  obtain  it  by  addressing  him 
at  the  Pan  American  Union,  Washington,  D.  C. 


C    E 


HO 
<     . 

MO 

W< 

pz 


s    Q 


•-  eg 


■-  c 

3   t- 


O 


m  eg  o 


£-2G 
o  •- 


£uu 


p~  S 

'n  u 
cg'Er? 

E«~ 
2^  o 

eg  O  ig 
fo     -3 

o 


d 


fct. 

<W 
Z~ 


u  eg  ^j  \z 

5  £Pc 

eg 
Ph 


P   E 


oE~  = 


•J  G     ..= 
•n  eg  o  <■> 

<^  eg  eg 

^P°o 

uS.«  .' 

:  o-a  ■• 

-  u  u 

O  .  eg  o 

'G  eg  3T3 

^z"  benr  eg 

p-l  «(jj   3 


-ii   O 
eg-- 

ej  o^l^  u 
3U -' 


bo  a> 

uP    g 

p  -5 


<HH  Ol- 


3  a;  eg 

P  orpreg 


egi— K 


0>=i  1 


3  u  °  o^  o 


eg  j3  v 

|g..s 


U-2-°.2 

°o  .-5 


^  a; 


:=.< 


„-o 


'£<" 


_o  o  eg 

"3  eg  .2 

J-.   eg   rt 

c<  E 

...Ofe 


£•0  o 
rz  <u  c    • 
".tS  egffl 

^  E  S 

I-  «    3 

•£■< 

■g  oJP 

M>  eg  " 
u  fcW  « 

".fig 


o~  °  o 

>  C    D 

r*  M.-3 

eg  O  3  °- 

SE<u.« 

[.•jfl    3 

«jPh  ..•-* 

-  eg—   u 

Ji^-^P 
3  =  U 

«^^   « 
D       T1  — 


fe5  «iz 

■"5  u  %  « 

eg      wryj 

Uj{rr  o 

a  k      c 

u  u  „'  b- 

^  JS  i- 

!  o  eg' 


be 


:p  ■- 


up 


V 


E1- ''^  o 

2-B-gO 

■a 


:- 


t.     .  i  o  eg 
O'-C  u'x 

u-O^P 


--  u 


TRANSACTIONS  OF  THE  FIFTH 

INTERNATIONAL  SANITARY  CONFERENCE 

OF  THE  AMERICAN  REPUBLICS 


HELD  IN    SANTIAGO   DE  CHILE, 

NOVEMBER  5  TO  11 

1911 


f*&l 


PUBLISHED  AND  DISTRIBUTED  UNDER  THE  AUSPICES  OF  THE 
PAN  AMERICAN  UNION,  JOHN  BARRETT,  DIRECTOR- 
GENERAL,  WASHINGTON,  D.  C. 


Press  of  Byron  S.  Adams, 
Washington,  D.  C. 


\    0  a 


INDEX. 

PAGE. 

Call    for  the   Fifth   International   Sanitary   Conference J 

List    of    Delegates     5 

Officers  and  Committees  of  the  Conference   6 

Officers  of  the  International   Sanitary  Bureau   of  Washington 7 

Officers  of  the  Sanitary  Information  Bureau  of  Montevideo 7 

Delegates  of  the  International  Sanitary  Bureaus  of  Washington  and  Monte- 
video   and    Members    of    the    International    Sanitary    Information 

Committees    9 

Program  of  the  Fifth  International  Sanitary  Conference 10 

Transactions  of  the  Fifth  International  Sanitary  Conference  of  the  Ameri- 
can Republics. 
First  day,  Sunday,  November  5,  1911 — 

Afternoon — Opening    Session    15 

Second  day,  Monday,  November  6,   1911 — 

Morning  Session    26 

Afternoon   Session    28 

Third  day,  Tuesday,  November  7,  1911 — 

Afternoon   Session    34 

Fourth  day,  Wednesday,  November  8,   1911 — ■ 

Afternoon   Session    36 

Fifth  day,   Thursday,   November  9,   1911 — 

Afternoon   Session    39 

Sixth  day,  Friday,  November  10,  1911 — 

Morning  Session    41 

Afternoon   Session    i 47 

Seventh  day,  Saturday,  November  11,  1911 — 

Morning  Session    53 

Afternoon — Closing   Session    61 

Appendix : 

Festivities  and  social  functions  in  honor  of  the  delegates 67 

Resolutions  passed  by  the  Fifth  International  Sanitary  Conference....  68 

Reports   of  the   Committees    71 

Reports  presented  by  the  Delegations : 

Argentine    Republic    77 

Bolivia   81 

Brazil   87 

Chile  .   .   91 

Costa    Rica    97 

Cuba   101 

Ecuador 107 

El    Salvador    Ill 

Guatemala   113 

Mexico 117 

Paraguay  119 

United   States    , 121 

Uruguay 153 

Venezuela 159 


CALL    FOR    THE    FIFTH    INTERNATIONAL    SANITARY 

CONFERENCE. 

In  accordance  with  the  resolution  adopted  at  the  Fourth  International  Sanitary 
Conference,  held  in  the  city  of  San  Jose,  Costa  Rica,  from  December  25,  1909, 
to  January  3,  1910,  the  date,  November  1-12,  1911.  has  been  fixed  for  the 
assembling  of  the  Fifth  International  Sanitary  Conference  in  the  city  of  San- 
tiago, Chile. 

The  following  official  correspondence  in  regard  to  the  call  and  the  pro- 
visional program  of  the  Conference  are  printed  in  the  interest  of  the 
Conference. 

International  Sanitary  Bureau, 
Washington,  D.  C,  May  10,   1911. 
Honorable  John  Barrett, 

Director  General,  Pan  American  Union, 
Washington,  D.  C. 

Sir: 

In  accordance  with  a  resolution  adopted  at  the  Fourth  International  Sanitary 
Conference,  held  at  San  Jose,  Costa  Rica,  December  25,  1909,  to  January  3, 
1910,  and  with  the  approval  of  the  International  Sanitary  Bureau,  I  inclose 
herewith  a  call  for  the  meeting  of  the  Fifth  International  Sanitary  Conference. 
A  copy  of  the  provisional  program  that  will  govern  the  deliberations  of  the 
conference  is  also  inclosed. 

I  have  also  to  request  that,  pursuant  to  the  provisions  of  Paragraph  7  of 
the  resolutions  relative  to  sanitary  police,  adopted  at  the  Second  International 
Conference  of  American  States,  you  take  the  necessary  measures  to  announce 
this  call  and  bring  the  provisional  program  to  the  notice  of  the  governments 
concerned. 

It  is  understood  that  the  proper  representations  will  be  made  by  your 
office  to  the  Legation  of  Chile,  so  that  the  invitations  to  the  Conference  may 
be  jointly  issued  by  that  Government. 

Respectfully, 

(Signed)     Walter    Wyman, 
Chairman,  International   Sanitary   Bureau. 


FIFTH  INTERNATIONAL  SANITARY  CONFERENCE  OF  THE  AMER- 
ICAN REPUBLICS, 
To  Be  Held  in  the  City  of  Santiago,  Chile,  November   1-12,   1911. 
International  Sanitary  Bureau  of  the  American  Republics, 

Washington,  D.  C,  May  12,  1911. 
Announcement  is  hereby  made  that,  in  compliance  with  a  resolution  adopted 
at  the  Fourth  International  Sanitary  Conference,  the  Fifth  International  Sani- 
tary Conference  of  the  American  Republics  will  be  held  in  Santiago,  Chile, 
November  1-12,  1911,  under  the  presidency  of  Dr.  Alexander  Del  Rio  and  the 
auspices  of  the  Chilean  Government. 

The  attendance  of  representatives  of  every  American  republic  is  earnestly 
desired,  including  those  which  have  not  taken  part  in  previous  conferences. 

As  stated  in  the  Provisional  Program,  a  number  of  subjects  will  be  dis- 
cussed at  Santiago,  which  are  of  vital  interest  to  all  the  nations  of  this  con- 
tinent, and  it  is  expected  that  the  deliberations  of  this  Conference  will  be  fully 
as  important  and  fruitful  in  results  as  the  preceding  ones.  The  provisional 
program  which  follows  is  subject  to  amendment  or  revision,  as  may  subse- 
quently seem  advisable. 


Provisional  Program  for  the  Fifth  International  Sanitary 
Conference  of  the  American  Republics,  to  be  Held  in  the 
City  of  Santiago,  Chile,  November  1-12,  1911. 

1.  Reports   by   the   several   delegations   in   regard   to   the   sanitary   legislation 
enacted  in  their  respective  countries  since  the  last  Conference. 

2.  Special  reports  relative  to  the  means  employed   in  the   different  countries 
for  the  enforcement  of  the  resolutions  agreed  to  in  the  last  Convention. 

3.  Reports    discussing    the    vital    and    morbidity    statistics    of    each    country 
during  the  last  two  years. 

4.  Special   reports   on   the   sanitary  progress    of   the   principal   cities    in    each 
country. 

5.  Discussion  of  measures  relative  to  social  hygiene,  with  special  reference 
to  venereal  diseases. 

6.  Determination  of  what  constitutes  immunity  to  yellow  fever. 

7.  Discussion  of  hygiene  of  sea  traffic,   having  in  view  specially  systematic 
measures   for  the  deratization   of   ships. 

8.  Discussion   of   hygiene  of  tramway   and   railroad   traffic. 

By    direction    of   the    International    Sanitary    Bureau    of    the    American    Re- 
publics. 

Walter  Wyman, 

Chairman. 


As  requested  in  the  communication  of  Dr.  Walter  Wyman,  Chair- 
man of  the  International  Sanitary  Bureau,  the  Director  General  of  the 
Pan  American  Union  has  addressed  a  letter  to  the  diplomatic  represen- 
tatives of  the  countries  interested  in  the  Conference  transmitting  a 
copy  of  the  call,  and  the  Provisional  Program,  which  has  also  been 
given  to  the  press,  and  will  be  printed  in  the  Bulletin  of  the  Pan 
American  Union. 


DELEGATES. 

I.-Argentine   Republic }  £r-  Gregorio  Araoz  Alfaro. 

(  Dr.  Fernando  Alvarez. 

2. — Bolivia   Dr.  Claudio  Sanjines. 

2 rr^zil  |  Dr.  Ismael  da  Rocha. 

{  Dr.  Antonino  Ferrari. 

4. — Colombia   Dr.  Alcibiades  Vicencio. 

5. — Costa  Rica Dr.  Fernando  Iglesias. 

6. — Cuba    Dr.  Hugo  Roberts. 

7.— Dominican    Republic f  Senor  Tito  V.  Lizoni. 

(  Dr.  J.  Ramon  Campos. 

8. — Ecuador   Dr.  Luis  Felipe  Cornejo  y  Gomez. 

g tjnited    States  (Dr.  Gregorio  M.  Guiteras. 

\  Dr.  J.  C.  Perry. 
10.— Guatemala   |  Dr.  Salvador  Ortega. 

(  Dr.  JULIO   BlANCHI. 

11. — Honduras    Senor  Oscar  Valenzuela  Valdes. 

12. — Mexico   Dr.  Jesus  Monjaras. 

13. — Panama   Dr.  Caupolican  Pardo  Correa. 

14. — Paraguay Dr.  Rojelio  Urizar. 

15. — Salvador    Dr.  Juan  B.  Miranda. 

16_ Uruguay  ^  Dr.  Ernesto  Fernandez  Espiro. 

)  Dr.  Jaime  H.  Oliver. 

17._Venezuela    f  Dr-  Pablo  Acosta  Ortiz 

( Dr.  Luis  Razetti. 
18. — Chile: 


OFFICIAL  DELEGATION. 

Executive  Committee. 

Provisional  President :     Dr.  Alejandro  del  Rio. 

Secretary  to  the  Delegation :     Dr.  Gregorio  Amunategui. 

Treasurer  :     Dr.  Octavio  Maira. 

Members :  Dr.  Paulino  Alfonso,  Dr.  Luis  Asta-Buruaga,  Dr.  Mamerto 
Cadiz,  Dr.  Lucio  Cordova,  Dr.  Ramon  Corbalan  Melgarejo,  Dr.  Pedro  Lau- 
taro  Ferrer,  Dr.  Eduardo  Moore,  Dr.  Manuel  Camilo  Vial. 

Members  of  the  Delegation  : 

Dr.  Vicente  Izquierdo,  Dr.  Roberto  del  Rio,  Dr.  Ricardo  -Davila  Boza, 
Dr.  Francisco  Landa,  Dr.  ALciBiADES  Vicencio,  Dr.  Eduardo  GarcIa  Collao, 
Engineer  Jorge  Calvo  Mackenna,  Dr.  Conrado  Rios,  Dr.  Ernesto  Soza, 
Dr.  Waldo  Silva  Palma,  Dr.  Alberto  Adriazola,  Engineer  Guillermo  Illaxes, 
Dr.  Carlos  Altamirano,  Dr.  Daniel  Carvallo,  Dr.  Benjamin  Manterola, 
and  Dr.  Enrique  Deformes. 


OFFICERS  OF  THE  CONFERENCE. 

President. 

Doctor  Alejandro  del  Rio,  Chile. 

Vice-Presidents. 

Doctor  Gregorio  Araoz  Alfaro,  Argentine  Republic. 

Doctor  Claudio  Sanjines,  Bolivia. 

Doctor  Ismael  da  Rocha,  Brazil. 

Doctor  Alcibiades  Vicencio,  Colombia. 

Doctor  Fernando  Iglesias,  Costa  Rica. 

Doctor  Hugo  Roberts,  Cuba. 

Sefior  Tito  V.  Lizoni,  Dominican  Republic. 

Doctor  Luis  F.  Cornejo  y  Gomez,  Ecuador. 

Doctor  Gregorio  M.  Guiteras,  United  States. 

Doctor  Salvador  Ortega,  Guatemala. 

Sefior  Oscar  Valenzuela  Valdes,  Honduras. 

Doctor  Jesus  Monjaras,  Mexico. 

Doctor  Caupolican  Pardo  Correa,  Panama. 

Doctor  Rogflio  Urizar,  Paraguay. 

Doctor  Juan  B.  Miranda,  Salvador. 

Doctor  Ernesto  Fernandez  Espiro,  Uruguay. 

Doctor  Pablo  Acosta  Ortiz,  Venezuela. 

Secretaries. 

Doctor  Grecorio  Amunategui,  Chile. 
Doctor  Jaime  C.  Perry,  United  States. 
Doctor  Luis  Razetti,  Venezuela. 

Committee  on  Credentials. 

Sefior  Paulino  Alfonso,  Chile. 
Doctor  R.  Corbalan  Melgarejo,  Chile. 
Doctor  Vicente  Izquierdo  S.,  Chile. 
Doctor  Caupolican  Pardo  Correa,  Panama. 

Executive  Committee. 

Doctor  Alejandro  del  Rio,  Chile. 

Doctor  Fernando  Alvarez,  Argentine  Republic. 

Doctor  Ismael  da  Rocha,  Brazil. 

Doctor  Gregorio  M.  Guiteras,  United  States. 

Doctor  Jesus  Monjaras,  Mexico. 

Doctor  Ernesto  Fernandez  Espiro,  Uruguay. 

Committee  on  Plague. 

Doctor  Antonino  Ferrari,  Brazil. 

Doctor  Pedro  L.  Ferrer,  Chile. 

Doctor  Luis  F.  Cornejo  y  Gomez,  Ecuador. 

Committee  on  Malaria  and  Yellow  Fever- 
Doctor  Claudio  Sanjines,  Bolivia. 
Doctor  Hugo  Roberts,  Cuba. 
Doctor  Jaime  C.  Perry,  United  States. 

Committee  on  Cholera. 

Doctor  Gregorio  Araoz  Alfaro,  Argentine  Republic. 

Doctor  Luis  Asta-Buruaga,  Chile. 

Doctor  Gregorio  M.  Guiteras,  United  States. 

Committee  on  Sanitation   of  Sea  and  Frontier  Cities. 

Doctor  Carlos  Altamirano,  Chile. 
Engineer  Jorge  Calvo  Mackenna,  Chile. 


FIFTH    INTERNATIONAL   SANITARY   CONFERENCE. 

Doctor  Ricardo  Davila  Boza,  Chile. 
Doctor  Eduardo  Garcia  Collao,  Chile. 
Engineer  Guillermo  Illanes,  Chile. 
Doctor  Manuel  Camilo  Vial,  Chile. 
Doctor  Jaime  H.  Oliver,  Uruguay. 

Committee  on  Prophylaxis  of  Acute  Transmissible  Diseases. 

Doctor  Francisco  Landa,  Chile. 
Doctor  Alcibiades  Vicencio,  Colombia. 
Doctor  Fernando  Iglesias,  Costa  Rica. 
Doctor  Juan  B.  Miranda,  Uruguay. 
Doctor  Pablo  Acosta  Ortiz,  Venezuela. 

Committee   on   Prophylaxis   of   Chronic   Transmissible   Diseases. 

Doctor  Roberto  del  Rfo,  Chile. 
Doctor  Ernesto  Soza,  Chile. 
Doctor  Salvador  Ortega,  Guatemala. 
Doctor  Rogelio  Urizar,  Paraguay. 


Officers  of  the  International  Sanitary  Bureau  of  Washington,  D.  C. 

Chairman. 

Surgeon-General  Doctor  Walter  Wyman,  United  States,  deceased. 

Members. 

Doctor  Alejandro  del  Rio,  Chile. 
Doctor  Hugo  Roberts,  Cuba. 
Doctor  Oscar  Dowling,  United  States. 
Doctor  Salvador  Ortega,  Guatemala. 
Doctor  Eduardo  Liceaga,  Mexico. 
Doctor  Luis  Razetti,  Venezuela. 


International  Sanitary  Information  Bureau  of  Montevideo. 

Chairman. 
Doctor  Ernesto  Fernandez  Espiro. 

Members. 

Doctor  JoAQufN  de  Salterain. 
Doctor  Julio  Etchepare,  Secretary. 


DELEGATES  OF  THE  INTERNATIONAL  SANITARY  BU- 
REAUS OF  WASHINGTON  OR  MONTEVIDEO  AND 
MEMBERS  OF  THE  INTERNATIONAL  SANITARY  IN- 
FORMATION COMMITTEES. 


fDr.  Manuel  Cuellar. 

Bolivia  \  Dr.  ELf as  Sagarnaga. 

I  Dr.  Enrique  Aranibar. 

[Dr.  A.  Davila  Boza. 

^HILE  i  Dr.  Pedro  L.  Ferrer. 

I  Dr.  Lucio  Cordova. 

_           _  fDr.  Carlos  Duran. 

Costa   Rica J  Dr.  Elias  Rojas. 

[Dr.  Jose  Maria  Soto. 

fDr.  Juan  Guiteras. 

Cuba j  Dr.  Enrique  B.  Barnet. 

1  Dr.  ArIstides  Agramonte. 

fDr.  A.  H.  Glennan. 
United  States  of  America J  j)r   j    y/    Kerr 

LDr.  John  W.  Trask. 

_  fDr.  Salvador  Ortega. 

Guatemala    •  •  •     Dr.  Juan  J.  Ortega. 

L  Dr.  Julio  Bianchi. 

TT  fDr.  Jose  M.  Ochoa  Velasquez. 

Honduras  J  Dn  iGNACI0  Castro. 

LDr.  Juan  Angel  Arias. 

fDr.  Luis  Debayle. 
Nicaragua    I  Dr   rODOLfo  Espinosa. 

[Dr.  Juan  B.  Sacoza. 

-.  fDr.  Eduardo  Liceaga. 

Mexico    j  Dr.  Jesus   MonjarAs. 

I  Dr.  Nicolas  Ramirez  de  Arellano. 

fDr.  Luis  Urriola. 

rANAMA    \  Dr.  Alfonso  Preciado. 

LDr.  Augusto  S.  Boyd. 

c  fDr.  Tomas  G.  Palomo. 

Salvador  J  Dr.  Francisco  Guevara. 

LDr.  Rafael  B.  Castro. 

,r  *  fDr.  Pablo  Acosta  Ortiz. 

J  Dr.  Carlos  Manuel  de  la  Cavada. 
Dr.  Luis  Razetti. 


Program  of  the 

Fifth  International  Sanitary  Conference  of  the 

American  Republics, 

To  be  Held  in  Santiago  de  Chile  From  the  5th  to  the  12th  of  November, 

1911. 

1.  Sanitary  laws,  regulations  and  measures  adopted  in  each  country  since  the 
Fourth    Conference. 

2.  Fulfilment  of  the  resolutions  adopted  in  the  first  four  sanitary  Conferences. 

3.  Report  relating  to  the  adoption  of  the  Convention  of  Washington  of  1905 
and  of  the  modifications  of  its  9th  article  by  the  4th  International  Sanitary 
Conference  and  the  4th  International  American  Conference  (of  Buenos  Aires) 
(Note  A). 

4.  Constitution  and  work  of  the  reporting  International  Sanitary  Com- 
missions. 

5.  Sanitation  of  cities  and  specially  of  ports  indicating  the  participation  which 
the  National  Government  has  had  in  the  execution  of  these  works. 

6.  Prophylactic  measures  taken  against  plague,  cholera  and  yellow  fever,  with 
special  mention  of  the  methods  employed  for  the  destruction  of  rats,  flies 
and  mosquitoes. 

7.  Criterium  by  which  the  health  authorities  must  be  guided  to  determine 
when  a  person  shall  be  considered  immune  from  yellow  fever. 

8.  National  and  international  protective  measures  relating  to  tuberculosis, 
venereal  diseases,  small-pox,  malaria,  tracoma,  leprosy  and  scleroma  (Note  B). 
Legislation  adopted  against  these  diseases  and  the  results  obtained. 

9.  Monthly  and  yearly  statistics  of  morbidity  and  mortality  in  the  principal 
ports  and  cities ;  information  in  regard  to  the  adoption  of  Bertillon's  nomen- 
clature. 

10.  Sanitary  inspection  of  international  maritime  and  terrestrial  traffic  in 
case  of  communicable  or  quarantinable  diseases;  their  specification.  Regula- 
tions relating  to  the  retention  or  devolution  of  patients  in  such  circumstances. 

11.  Sanitary  laws  on  immigration. 

12.  Data  on  the  adoption  of  maritime  sanitary  documents  approved  by  the 
4th    Conference. 

Note  A. — Art.  9  of  the  Convention  of  Washington  says :  "Art.  9.  In  order 
that  a  locality  be  considered  free  of  contagion,  it  is  necessary  to  furnish  the 
official  proof:  1st.  That  there  have  been  no  deaths  nor  new  cases  of  plague 
or  cholera  for  five  days  after  the  isolation,  death  or  discharge  of  the  last  case 
of  plague  or  cholera ;  in  the  case  of  yellow  fever  the  period  shall  be  eighteen 
days,  but  each  government  reserves  the  right  to  prolong  this  period.  2d.  That 
all  measures  of  disinfection  have  been  applied,  and  in  treating  of  plague  cases 
that  there  have  been  carried  out  all  measures  for  the  destruction  of  rats, 
and  in  case  of  yellow  fever  that  the  proper  measures  have  been  taken  against 
mosquitoes." 

The  modification  introduced  by  the  Fourth  International  Sanitary  Conference 
(San  Jose  de  Costa  Rica,  1909-10),  says:  "This  Fourth  Sanitary  Conference 
recommends  that  Article  9  of  the  Convention  of  Washington  be  interpreted  as 
follows :  Art.  9.  In  order  that  a  locality  be  considered  free  of  contagion  it  will 
be  necessary  to  furnish  official  proof  to  the  satisfaction  of  the  interested 
party:  1st.  That  there  have  been  no  deaths  nor  new  cases  of  plague  or  cholera 
for  five  days  after  the  isolation,  death  or  discharge  of  the  last  case  of  plague 
or  cholera ;  in  case  of  yellow  fever  the  period  shall  be  eighteen  days,  but  each 
government  reserves  the  right  to  prolong  this  period  against  those  countries 
where  the  measures  for  the  isolation  of  cases,  the  destruction  of  mosquitoes 
and  the  disinfection  of  foci  are  not  observed.  2d.  That  all  measures  of  disin- 
fection have  been  applied,  and  in  treating  of  plague  cases  that  there  have  been 
carried  out  all  measures  for  the  destruction  of  rats;  and  in  the  case  of  yellow 
fever  that  the  proper  measures  have  been  taken  against  mosquitoes." 


FIFTH    INTERNATIONAL   SANITARY   CONFERENCE.  11 

The  Fourth  International  American  Conference,  held  in  Buenos  Aires,  re- 
solved to  draw  up  Art.  9  of  the  Conference  of  Washington  thus:  "In  order 
that  a  locality  be  considered  free  of  contagion,  it  will  be  necessary  to  furnish 
official  proof  to  the  satisfaction  of  the  interested  parties,  etc.  (the  rest 
similar  to  the  modification  introduced  by  the  Fourth  International  Sanitary 
Conference). 

Note  B. — This  new  subject  has  been  introduced:  1st.  Because  it  is  a  disease 
which  has  a  tendency  to  extend  from  its  primitive  homes  and  become  a  scourge 
which  must  be  taken  into  account;  2d.  Because  there  exist  in  America,  aside 
from  sporadic  cases,  two  well  characterized  foci,  San  Salvador  and  Chile; 
3d.  Because  it  is  a  theme  for  study  recommended  by  the  1st  Pan  American 
Scientific  Congress  (Chile,  1908)  ;  and  4th.  Because  its  study  constitutes  to-day  a 
motive  of  world-wide  interest,  as  shown  by  the  resolution  taken  at  the  Sixteenth 
International  Congress  of  Medicine  (Buda-Pesth,  1909),  whereby  a  permanent 
commission  was  appointed  with  that  object,  and  of  which  are  members,  among 
others,  Doctors  Freudental  and  Meyer,  of  the  United  States  of  America,  and 
Dr.  A.  del  Rio,  of  Chile ;  the  formation  of  an  international  league  with  its 
seat  at  Vienna,  and  the  future  meeting  of  a  conference  in  said  city  for  carrying 
out  this  purpose. 

Recommendations. 

1.  The  Government  of  the  American  Republics  are  recommended  that,  for 
future  Sanitary  Conferences,  it  is  convenient  to  nominate  delegates  who  have 
assisted  at  previous  Conferences ;  and  when  the  delegations  are  composed  of 
more  than  one  member,  that  at  least  one  of  them  shall  meet  the  foregoing 
requisite,  or  that,  in  any  case,  the  delegates  shall  be  sanitary  authorities  in 
their  respective  countries. 

2.  Each  delegation  shall  present  a  paper  or  report  which  shall  deal  precisely 
and  necessarily  with  the  subject  marked  out  in  this  program,  and  also  a  concise 
extract  of  the  same  to  be  read  within  fifteen  minutes'  time  at  the  sessions. 
Each  extract  shall  be  printed  in  Spanish  and  English;  that  of  Brazil  in 
Portuguese  and  English,  and  that  of  Hayti  in  French  and  English. 


TRANSACTIONS  OF  THE  FIFTH 

INTERNATIONAL  SANITARY  CONFERENCE 

OF  THE  AMERICAN  REPUBLICS. 


FIFTH  INTERNATIONAL  SANITARY  CONFER- 
ENCE OF  THE  AMERICAN  REPUBLICS. 


FIRST  DAY— SUNDAY,  NOVEMBER  5,  1911. 
Afternoon — Opening  Session. 

At  2  o'clock  in  the  afternoon  there  assembled  in  the  Hall  of  Honor 
of  the  National  University  of  Chile,  in  the  city  of  Santiago,  the  Dip- 
lomatic and  Consular  Corps,  the  Delegates  to  the  Conference,  and 
members  of  the  Chilean  National  Congress,  of  the  Courts  of  Justice, 
of  the  Council  of  Public  Instruction,  of  the  Superior  Council  of 
Health,  of  the  various  Faculties  of  the  University,  of  the  Board  of 
Benefkience,  etc.  Shortly  after  two  o'clock,  the  President  of  the  Re- 
public, the  Ministers  of  the  Interior,  of  Foreign  Affairs,  and  of  Pub- 
lic Instruction,  the  Presidents  of  the  Senate  and  of  the  Chamber  of 
Deputies,  the  Rector  of  the  University,  the  Provisional  President  of 
the  Conference,  the  Dean  of  the  Faculty  of  Medicine,  the  Secretary 
General  of  the  University,  the  Secretary  of  the  Chilean  Delegation, 
and  the  Aide-de-Camp  to  the  President  of  the  Republic,  occupied  the 
places  of  honor. 

The  formal  inauguration  of  the  Conference  was  then  begun  in  the 
following  manner: 

The  Minister  of  Foreign  Affairs,  Sr.  Enrique  A.  Rodriguez: 

The  Republic  of  Chile  rejoices  on  having  as  its  guests  the  dis- 
tinguished scientific  personages  who  have  gathered  in  this  city  for  the 
purpose  of  studying  and  solving  the  high  and  varied  problems  tending 
to  establish  the  best  ways  of  preserving  human  life.  And  in  behalf 
of  the  Supreme  Government,  I  have  the  honor  to  welcome  the  Dele- 
gates of  the  Fifth  International  Sanitary  Conference. 

It  is  gratifying  to  note  that  these  Conferences  have  been  increas- 
ing the  number  of  adherences  by  the  American  Governments,  and 
Chile  congratulates  itself  on  this  occasion  for  having  been  honored 
with  the  attendance  of  the  official  delegates  from  seventeen  Republics 
of  the  three  Americas.  The  Government  expresses  a  national  feeling 
by  extending  to  you,  on  this  solemn  occasion,  its  thanks  for  so  high  a 
distinction,  which  it  owes  to  those  Republics  as  well  as  to  their  men  of 
science,  many  of  whom  have  already  brilliantly  collaborated  in  pre- 
vious Conferences. 

These  periodic  Conferences,  created  by  the  Second  Pan  American 
Conference  (1901-1902),  are  inspired  not  only  by  an  idea  of  preser- 
vation, but  also  by  an  urgent  spirit  of  altruism,  because  they  are 
beneficial  to  the  American  Republics  and  to  humanity  in  general.  The 
meetings  devoted  to  the  interesting  study  of  international  and  public 
hygiene,  define  the  measures  of  defense  that  the  countries  must  adopt 
in  order  to  prevent  the  propagation,  through  their  littorals  and  fron- 


16  FIFTH    INTERNATIONAL   SANITARY   CONFERENCE. 

tiers,  of  transmissible  diseases,  such  as  cholera,  plague,  and  yellow- 
fever,  and  at  the  same  time  they  encourage  Governments  to  check  the 
development  of  epidemics,  by  improving  the  interior  sanitary  condi- 
tions of  each  country. 

The  scientific  discussions  that  take  place  in  these  Conferences,  the 
exchange  of  ideas  among  the  sanitary  representatives,  must  neces- 
sarily wield  a  positive  influence  upon  the  hygienic  measures  of  our 
Republics.  Aside  from  its  undisputed  scientific  merit,  these  meet- 
ings also  realize  a  generous  international  work,  free  from  the  con- 
ventional forms  of  the  Foreign  Offices.  The  intercourse  amongst 
superior  men  who  contribute  efficiently  towards  the  direction  of  the 
intellectuality  of  the  peoples  of  America,  assures  and  strengthens  fra- 
ternal sentiments ;  it  creates  special  ties  of  friendship  which  concur 
in  the  realization  of  the  ideals  of  peace  and  harmony  that  might  tend 
to  constitute  their  highest  aspiration.  It  enables  them  to  know  with- 
out any  effort,  the  social  structure,  the  mechanism  of  public  institu- 
tions, their  economic  force,  the  industrial,  scientific  and  literary  prog- 
ress, and,  in  a  word,  everything  that  gives  the  stamp  of  civilization 
and  progress,  and  that  marks  the  importance  of  civilization  and  prog- 
ress in  the  New  World. 

Reviewing  the  work  of  the  four  previous  Conferences,  the  first 
two  held  in  Washington  in  1902  and  1905,  respectively,  the  third  in 
Mexico,  in  1907,  and  the  fourth  in  San  Jose  de  Costa  Rica,  in  1909, 
we  see  what  has  been  done  in  our  continent  in  the  interest  of  public 
health. 

It  is  thus  that  the  conquests  of  science  open  up  new  ways.  Public 
health,  one  of  the  principal  conditions  for  the  vitality  of  nations, 
should  also  be  one  of  the  principal  aims  of  all  governments. 

Chile  has  been  represented  in  all  the  previous  Sanitary  Confer- 
ences, whose  resolutions,  reported  to  the  Government  by  our  Dele- 
gates, have  been  made  subject  of  special  study  and  interest.  It  has 
been  the  wish  of  the  Government  to  submit  to  this  assembly  of  emi- 
nent experts  a  brilliant  record  of  work  done  for  improving  public 
health.  But  unfortunate  circumstances,  unavoidable  and  unforseen 
catastrophies,  such  as  the  earthquake  of  1906,  the  material  damages 
caused  thereby  it  has  been  necessary  to  attend  to  first,  have  prevented 
it  from  achieving  its  aspirations. 

The  water  supplies  established  in  all  provincial  and  departmental 
capitals,  and  the  sewer  systems  that  have  been  or  are  nearly  completed 
in  ten  cities  of  the  Republic,  constitute  only  a  portion  of  the  projects 
that  we  are  determined  to  carry  out.  New  means  of  maritime  and 
land  communication  will  facilitate  the  intercourse  among  our  Repub- 
lics and  will  put  us  in  closer  contact  with  Europe;  but  it  is  necessary 
to  devote  our  attention  to  the  sanitary  prophylaxis  that  such  progress 
demands,  as  a  guaranty  that  must  be  offered  by  every  civilized  nation. 
All  nations  are  solidarily  responsible  as  to  everything  that  concerns 
public  health,  and  no  good  result  can  be  accomplished  without  a  com- 
mon action. 

The  labor  of  every  new  Conference  will  have  to  be  more  arduous 
and  complicated,  but,  gentlemen,  you  may  rest  assured  that  to  stimu- 
late your  work  you  may  depend  upon  all  governments  directly  inter- 
ested in  the  success  of  the  resolutions  that  may  be  passed. 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  17 

Messrs.  Delegates :  Your  attendance  in  this  Convention,  and  the 
distinguished  position  that  you  occupy,  are  in  keeping  with  the  just 
titles  and  merits  conquered  in  the  cultivation  of  science;  I,  therefore, 
predict  that  your  deliberations  will  be  crowned  by  most  brilliant  re- 
sults, and  trust  that  Chile  in  particular  will  derive  great  benefits  from 
your  enlightened  advices. 

His  Excellency,  the  President  of  the  Republic,  has  been  pleased 
to  show  you  by  his  presence  the  importance  that  he  attaches  to  the 
tasks  before  you,  and  in  his  name  I  declare  that  the  Fifth  Interna- 
tional Sanitary  Conference  is  opened. 

The  Provisional  President,  Dr.  Alejandro  Del  Rio: 

Mr.  President  of  the  Republic,  Messrs.  Ministers,  Messrs. 
Delegates  :  The  Fifth  International  American  Sanitary  Conference 
which  we  inaugurate  today  under  the  high  auspices  of  the  Chilean 
Government,  will  undoubtedly  mark  a  memorable  date  in  the  develop- 
ment of  sanitary  progress.  Hygiene,  a  science  which  only  a  few  de- 
cades ago  was  in  its  incipiency,  emerging  from  the  crucible  of  the 
experimental  method,  has  become  the  great  distributor  of  human 
health.  Its  principles  established  in  a  definite  form ;  its  investigation 
methods,  safer  and  more  rapid  from  day  to  day,  and  the  transcen- 
dental efficiency  of  a  result,  are  facts  that  already  stand  with  an  irre- 
sistible force  before  the  public  conscience. 

Exotic  diseases — be  they  plague,  cholera  or  yellow  fever — being 
known  today  by  their  causes  and  means  of  propagating,  are  now  easily 
controlled  by  the  joint  action  of  science  and  the  will  of  man.  Like- 
wise, endemic  or  epidemic  diseases,  whether  they  be  malaria,  typhoid 
fever  or  tuberculosis,  disappear  or  diminish  considerably  in  countries 
subject  to  the  influence  of  the  present  means  of  sanitation.  Hygiene 
nowadays  means  health  and  welfare  of  individuals  and  wealth  and 
prosperity  of  the  nation. 

For  a  long  time  and  only  until  recently,  a  decisive  importance — 
undoubtedly  exaggerated — was  attached  to  international  conventions 
establishing  more  or  less  strict  rules  of  sanitary  police  in  the  frontiers 
of  countries ;  but  these  great  hindrances  to  the  means  of  communica- 
tion among  men  and  to  commercial  intercourse  among  countries,  for 
the  sake  of  hygiene  wrongly  understood  and  applied,  have  now,  for- 
tunately, passed  to  history. 

The  great  Pettenkofer,  the  founder  of  scientific  hygiene,  was  per- 
fectly right  when  he  affirmed  that  no  frontiers  could  be  proof  against 
unhealthy  germs ;  this  affirmation,  though  discouraging  at  first,  has  a 
far-reaching  beneficial  effect,  because  it  diverts  the  attention  of  science 
and  the  action  of  governments  from  the  useless  and  harmful  chimera 
of  a  complete  frontier  defense ;  and  because  it  concentrates  such  atten- 
tion and  action  upon  the  only  substantially  fruitful  object  which 
should  be  considered  in  this  matter,  to  wit,  the  defense  of  the  nation 
"by  means  of  the  strength  of  her  citizens  and  by  the  success  of  the  re- 
spective national  methods  of  hygiene. 

Without  absolutely  disregarding  the  usefulness  of  conventions,  the 
success  of  the  sanitary  defense  of  every  country  depends,  in  the  first 
place,  upon  the  truth  of  the  principles  from  which  the  legislators  have 


18  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

derived  their  inspiration,  and,  in  the  second  place,  on  the  proper  or- 
ganization of  the  sanitary  services.  And  I  must  add  that  under  ordi- 
nary circumstances  these  are  the  factors  destined  to  eradicate  en- 
demic diseases  and  to  reduce  the  permanent  causes  of  unhealthiness. 

In  Chile  we  have  passed  slowly  through  the  first  stage  of  our 
emancipation  from  colonial  traditions  and  prejudices  of  ignorance. 
Our  geographic  position  and  the  obstacles  opposed  by  nature  to  our 
communication  with  the  centers  of  culture,  have  produced  a  percep- 
tible delay  in  the  sanitation  of  our  cities ;  but  the  consciousness  of  this 
delay  has  aroused  in  our  souls  a  noble  emulation  that  is  already  be- 
ginning to  be  fruitful,  and  that  will  undoubtedly  be  still  much  more 
so  in  the  future. 

During  the  sessions  of  the  Conference  we  shall  show  the  sanitary 
works  that  we  have  carried  out  and  the  elements  of  various  kinds  that 
have  contributed  towards  its  realization.  We  shall  also  show  frankly 
our  failures  and  deficiencies,  but  at  the  same  time  we  will  exhibit  the 
projects  for  improvements,  which  do  credit  to  our  efforts  and  hopes. 

Messrs.  Delegates :  I  have  the  high  honor  of  extending  to  you  in 
behalf  of  the  Chilean  Delegation,  our  most  respected  and  cordial 
welcome.  You  may  be  sure  that  the  people  of  Chile,  and  specially 
the  capital  of  the  Republic,  honored  by  your  presence,  join  us  in 
greeting  you. 

Various  circumstances  predict  a  brilliant  success  for  the  Fifth  Amer- 
ican Sanitary  Conference.     Yours  shall  be  the  honors. 

The  Secretary  of  the  Chilean  Delegation,  Dr.  Gregorio 
Amunategui  then  offered  the  floor  to  one  Delegate  of  each  nation,  by 
alphabetical  order. 

The  Delegate  from  the  Argentine  Republic,  Dr.  Araoz  Al- 
faro.  Mr.  President  of  the  Republic;  Messrs.  Ministers;  Mr.  Presi- 
dent ;  Messrs.  Delegates :  It  is  with  real  pleasure  that  the  Government 
of  the  Argentine  Republic  participates  in  this  high  gathering  of  scien- 
tific men,  a  conference  initiated  by  our  great  sister  of  the  north  for 
the  purpose  of  finding  the  most  perfect  solutions  to  the  great  and 
numerous  problems  that  affect  the  health  of  the  American  countries. 

By  initiating  this  series  of  sanitary  conferences,  the  United  States 
proved  that  that  great  nation  is  not  only  zealous  for  its  own  material 
and  moral  progress,  but  also  for  the  advancement  of  the  whole  Amer- 
ican Continent,  and  it  is  only  fitting  that  we  should  now  pay  that 
country  the  homage  of  our  gratitude  for  having  placed  under  its  high 
patronage  this  international  and  permanent  work. 

Therefore,  the  Argentine  Republic  is  gratified  at  taking  part  in  this 
task,  and  will  contribute,  through  our  modest  collaboration,  in  the 
study  and  solution  of  sanitary  problems,  so  that  America  shall  be,  not 
only  an  emporium  of  wealth  and  a  garden  of  natural  beauties,  but 
also  the  healthful,  good,  pleasant  and  generous  continent,  always  open 
to  the  fruitful  activities  of  all  industrious  men  of  the  world.  But 
however  great  may  be  the  satisfaction  of  the  Argentine  Delegates  for 
associating  in  this  noble  work,  it  is  not  as  great  as  their  gratification 
for  being  able  to  realize  it  now  under  the  auspices  of  the  Chilean 
Government  in  this  hospitable  country,  to  which  our  people  are  bound 
by  ties  so  old  and  a  most  deep  affection. 


FIFTH    INTERNATIONAL   SANITARY   CONFERENCE.  19 

Personally,  the  Argentine  Delegates,  already  bound  by  affection  and 
respect  to  all  the  eminent  men  here  assembled,  and,  very  specially 
to  the  Chilean  physicians,  hygienists  and  public  men,  express  their 
enthusiastic  wishes  that  this  Conference  may  produce  not  only  new 
ideas  concerning  sanitary  questions,  but  also  and  above  all,  practical, 
easy  and  efficient  solutions  tending  towards  the  achievement  of  the 
higher  degree  of  welfare,  health,  and  happiness  in  all  the  countries 
of  America.  And  we  undertake  the  task  with  enthusiasm  and  energy, 
in  community  of  aspirations  with  the  illustrious  of  all  the  American 
countries,  who  we  fraternally  embrace  under  the  egis  of  this  wise  and 
progressive  Government  and  in  the  midst  of  this  strong,  energetic  and 
intelligent  people. 

The  Delegate  from  Bolivia,  Dr.  Claudio  Sanjines.  Mr.  Presi- 
dent of  the  Republic ;  Mr.  Minister  for  Foreign  Affairs ;  Mr.  President 
of  the  Conference ;  Messrs.  Delegates  :  Having  been  selected  to  repre- 
snt  Bolivia  before  the  Fifth  International  Sanitary  Conference  of  the 
American  Republics,  it  is  my  high  honor  to  bring  personally  the  cordial 
greetings  that  the  Bolivian  Government  and  people  send  to  the  Chilean 
Government  and  people. 

And  to  me,  personally,  this  occasion  means  the  happiness  of  return- 
ing, after  a  few  years'  absence,  to  this  beautiful  section  of  the  Ameri- 
can continent,  the  land  where  I  spent  the  best  years  of  my  life,  on  a 
mission  of  concord  and  affection ;  to  meet  again  my  eminent  professors 
and  my  dear  companions,  with  whom  and  together  with  the  distin- 
guished Delegates  from  the  American  Republics,  we  will  now  under- 
take to  solve  the  problems  that  affect  the  suffering  humanity.  What 
a  great  work !     What  a  satisfaction  to  contribute  in  it ! 

I  believe  that  there  is  nothing  nobler  than  to  work  for  the  dissemi- 
nation of  hygiene,  for  the  eradication  of  epidermis,  and  to  make  of 
each  nation  a  healthful  home,  free  from  evils,  and  hereby  capable  of 
progress  upon  the  basis  of  health  and  strength. 

I  think  that  my  Government  in  designating  me  as  its  Delegate  to  this 
Conference  did  not  have  in  mind  the  scientific  training  with  which 
every  one  taking  a  seat  among  you  should  be  provided ;  I  believe  that 
I  was  selected  merely  because  I  pursued  my  medical  studies  here  in 
Chile ;  and  this  is  precisely  the  reason  why  I  have  accepted  a  mission 
so  difficult  as  well  as  honorable. 

In  closing,  I  make  fervent  vows  for  the  success  of  the  labors  that 
we  inaugurate  to-day 

The  Delegate  from  Brazil,  Dr.  Ismael  da  Rocha.  Mr.  Presi- 
dent of  the  Republic ;  Mr.  Minister  for  Foreign  Affairs ;  Messrs.  Min- 
isters ;  Mr.  President  of  the  Conference ;  Messrs.  Delegates : 
The  medical  Delegates  from  Brazil,  my  esteemed  colleague  and 
myself,  here  present,  with  the  valued  permission  of  Dr.  Ferreira,  our 
Minister  Plenipotentiary  near  this  Government,  rise  to  present  you 
the  sincerest  and  most  cordial  greetings  that  we  bring  from  the  Presi- 
dent of  the  United  States  of  Brazil,  Marshall  Hermes  da  Fonseca, 
and  from  Baron  de  Rio  Branco,  our  beloved  Minister  for  Foreign 
Affairs,  two  eminent  personalities,  who  now  renew  their  salutations 
through  our  medium,  together  with  the  expressions  of  the  very  old 
friendship  that  bind  the  people  of  Brazil  with  the  people  of  Chile. 
In  the  name  of  Brazil,  I  also  greet  with  the  greatest  consideration  and 


20  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

esteem  all  the  diplomatic  representatives  from  the  countries  of  Amer- 
ica, Europe  and  Asia,  and  very  specially  the  illustrious  Delegates 
from  the  American  Republic.  You  may  believe  that  my  Brazilian 
heart  vibrates  with  the  throbbings  of  extreme  joy  that  I  felt  upon 
touching  the  hospitable  soil  of  Chile. 

These  Conferences,  happily  initiated  by  the  United  States  Govern- 
ment in  Washington  in  1902  and  1905,  continued  in  Mexico  in  1907 
and  in  San  Jose  de  Costa  Rica  in  1909-10,  and  now  in  Chile,  assemble 
the  hygienists  of  North,  Central  and  South  Americas  to  study  the 
protection  and  prolongation  of  human  life,  by  means  of  the  supreme, 
eternal  and  superhuman  effort  of  medicine  for  the  purpose  of  averting 
death  and  desolation.  These  Conferences  enliven  and  stimulate  men 
of  science  in  that  intellectual  transfusion  among  men  devoted  to  the 
same  labors  and  researches,  collaborating  in  the  great  task  of  con- 
ciliating the  spirit  of  friendship  among  peoples ;  in  that  necessary  and 
progressive  international  American  fraternization.  This  is  the  idea 
that  brought  us  to  this  privileged  soil ;  which  idea  also  inspires  the 
wise  Government  that  guides  the  destinies  of  Brazil,  "generous  and 
fertile  soil,  industrious  and  peaceful  people,"  which  entertains  great 
hopes  from  the  pacific  seeds  planted  for  the  future,  "progressing 
rapidly,  without  deviating  from  its  traditions  of  liberation  and  without 
violating  the  rights  of  others."  "It  is  indispensable,"  said  the  illus- 
trious Baron  de  Rio  Branco  in  the  Latin- American  Congress  of  1905, 
"that  before  half  a  century,  four  or  five,  at  least,  of  the  most  important 
Latin-American  Nations,  following  the  example  of  our  great  sister  of 
North  America,  through  a  noble  emulation,  should  rival  the  most 
powerful  States  of  the  world  in  point  of  resources  and  prestige." 

This  Continent,  whose  territory  stretches  uninterruptedly  from  north 
to  south,  from  the  Arctic  Pole  to  the  southern  extreme  of  the  world ; 
this  Continent,  which  from  its  extensive  and  endless  coasts,  both  on 
the  Atlantic  and  the  Pacific,  overlooks  an  immensity  of  heaven  and 
sea,  with  an  unbroken  horizon,  absolving  from  the  framy  waves  and 
inhaling  from  the  echo  of  the  mountain  ranges  and  the  balmy  forests, 
the  pure  sentiments  inspired  by  nature;  this  continent,  which  has  the 
privilege  of  possessing  the  three  greatest  and  most  wonderful  basins 
of  the  Occident,  formed  by  the  Mississippi,  the  Amazon  and  the 
River  Platte,  to-day  fully  opened  to  the  world's  commerce ;  this  con- 
tinent, which  with  the  religion  of  Jesus  in  all  its  nationalities,  shows 
sublimely  and  altruistically  to  the  generations  the  Christ  of  the  Andes 
and  the  Statue  of  Liberty  in  the  Port  of  New  York ;  this  continent, 
so  vast,  which  without  transposing  its  domains,  finds  the  bear  of  the 
Pole  in  the  glacial  zone  and  the  butterfly  of  the  tropics  in  the  pic- 
turesque gardens  of  the  torrid  zone ;  this  continent,  with  volcanoes 
in  its  highest  peaks,  and  flexible  leaves  in  the  virgin  forest  or  in  the 
graceful  palm  trees  growing  near  its  placid  beaches ;  this  continent, 
which  has  gathered  under  varied  climates  different  races  in  process 
of  transformation ;  this  continent,  I  say,  this  America  of  ours  can  not 
retrograde ;  it  can  not  think  of  extermination  nor  death ;  it  must  by 
all  possible  means  increase  its  strength,  so  that  it  may  say  to  the 
nations  over  the  seas :  Oh,  glorious  and  beautiful  Europe,  we  owe 
thee  everything,  as  a  son  owes  everything  to  his  parents ;  we  owe  thee 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  21 

our  discovery,  our  first  steps,  our  civilization  and  our  commerce  and 
the  industrial  development  of  our  resources.  But  thine  children  have 
grown.  Behold  them,  strong  and  powerful,  and  trusting  on  the  peace- 
ful struggle  of  the  lofty  ideals  of  humanity.  Chile,  which  has  given 
the  world  this  admirable  example  through  its  never-disturbed  peace, 
shall  be  one  of  the  first  countries  on  which  that  glory  shall  fall,  in 
addition  to  those  which  it  has  already  won.  And  I  have  the  greatest 
pleasure  in  exclaiming,  long  live  Chile ! 

The  Delegate  from  Colombia,  Dr.  Alcibiades  Vicencio.  Gen- 
tlemen :  The  Republic  of  Colombia,  in  honoring  me  with  its  repre- 
sentation, cordially  participates  in  the  labors  of  the  Fifth  International 
Sanitary  Conference. 

The  discovery  of  the  continent  in  which  we  live  was  hailed  as  a 
blessing  to  humanity ;  a  blessing  of  wealth  because  of  the  treasures 
hidden  in  its  soil ;  a  blessing  of  beauty  because  of  the  splendor  of  its 
peerless  nature ;  a  blessing  of  life  because  of  its  immense  and  fertile 
territory.  We  are  the  lords  of  this  privileged  continent ;  we  are 
Americans,  and  upon  us  falls  the  responsibility  that  our  name  implies. 
The  different  countries  here  represented,  upon  uniting  their  effort  to 
defend  life  and  insure  the  welfare  of  their  citizens,  giving  the  science 
of  medicine  the  leading  part  to  which  it  is  entitled  in  the  social  and 
international  movement  of  the  peoples,  prove  the  high  degree  of  their 
culture,  and  show  that  they  feel  strongly  the  close  ties  of  solidarity  now 
binding  men  to  each  other.  In  the  name  of  the  Republic  of  Colombia, 
I  express  the  hope  that,  for  America's  good,  success  will  crown  the 
noble  effort  that  this  Conference  means. 

The  Delegate  from  Cuba,  Dr.  Hugo  Roberts.  Mr.  President  of 
Chile ;  Messrs.  Ministers  ;  Messrs.  Delegates  ;  Gentlemen  :  I  have  the 
honor  to  greet  you  in  the  name  of  the  Cuban  nation.  The  Republic 
of  Cuba  takes  a  deep  interest  in  all  sanitary  matters ;  in  those  belong- 
ing to  its  interior  regime  as  well  as  in  those  concerning  its  relations 
with  other  nations;  and  it  is  our  fondest  desire  that  these  Conferences 
may  strengthen  the  ties  of  union  among  American  Republics,  so  that 
we  may  love  each  other  as  true  brothers ;  and  that  they  be  also  bene- 
ficial to  humanity  in  general. 

Cuba  hopes  that  the  idea  born  in  our  minds  may  soon  be  converted 
into  positive  facts. 

The  Delegate  from  Ecuador,  Dr.  Luis  Felipe  Cornejo  y  Gomez. 
Mr.  President  of  the  Republic;  Mr.  Minister  for  Foreign  Affairs; 
Messrs.  Diplomatic  Representatives ;  Mr.  President  of  the  Conference ; 
Messrs.  Delegates ;  Gentlemen :  Honored  with  the  representation  of 
Ecuador  before  the  Fifth  International  Sanitary  Conference  of  the 
American  Republics,  I  fulfill  the  pleasant  duty  of  greeting,  in  the  name 
of  my  country,  the  glorious  Chilean  Nation  in  the  person  of  its  illus- 
trious President,  His  Excellency  Dr/ Ramon  Barros  Luco,  under  whose 
auspices  this  Conference  is  held.  At  the  same  time  I  extend  my 
respectful  greetings  to  the  distinguished  members  of  the  learned  sani- 
tary assembly  here  gathered. 

In  view  of  the  highly  humane  purposes  pursued  by  the  Sanitary 
Conferences  that  are  being  held  periodically  by  the  various  countries 
of  America,  it  is  to  be  hoped  that  the  present  one  will  be  as  the  others 


22  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

preceding,  plentiful  in  efficient  and   wise  resolutions  tending  to  the 
welfare  of  each  and  every  country  of  the  Continent. 

The  Delegate  from  the  United  States  of  America,  Dr.  Gre- 
gorio  M.  Guiteras.  Mr.  President  of  the  Republic ;  Messrs.  Minis- 
ters ;  Messrs.  Members  of  the  Diplomatic  Corps ;  Mr.  President  of 
the  Conference ;  Messrs.  Delegates ;  Ladies  and  Gentlemen :  In  the 
name  of  the  United  States  of  America  and  of  the  Delegation  of  that 
Republic,  I  have  the  distinguished  honor  of  greeting  Chile  and  its  rep- 
resentatives, as  well  as  the  other  delegation  of  our  sister  Republics  of 
the  Western  Hemisphere. 

Having  arrived  here  a  few  days  before  this  Conference  was  called 
to  order,  I  have  enjoyed  the  opportunity  of  observing  a  little  of  this 
country,  and  I  can  assure  you  that  these  observations  have  charmed 
me  and  aroused  my  admiration  for  a  country  where  human  work  has 
overcome  the  obstacles  presented  by  nature,  originating  by  reason  of 
those  very  obstacles,  the  existence  of  a  Latin  race,  virile  and  moral, 
which  for  its  civic  spirit  and  culture  can  be  favorably  compared  to  any 
other  nation  in  the  whole  world.  Unfortunately,  the  Chilean  race  is 
not  properly  known  in  our  country,  a  fact  due  mainly  to  the  distance 
separating  us.  If  the  people  of  both  countries  knew  each  other  better, 
they  would  like  each  other  better,  and  I  hope  that  the  day  is  not  far 
when  the  ties  of  friendship  now  binding  us  will  be  closer  for  the  good 
of  both  Republics. 

In  the  name  of  the  United  States,  I  thank  you  most  expressively  for 
the  distinguished  and  truly  warm  welcome  accorded  us  from  the 
moment  we  landed  on  Chilean  soil,  at  the  port  of  Arica,  until  arriving 
at  Santiago,  the  beautiful  capital  of  Chile. 

The  Delegate  from  Guatemala,  Dr.  Salvador  Ortega.  Mr. 
President  of  the  Republic ;  Mr.  President  of  the  Conference ;  Ladies ; 
Messrs.  Delegates :  The  Government  of  Guatemala,  which  has  taken 
a  great  interest  in  the  International  Sanitary  Conferences  of  the  Amer- 
ican Republics  from  the  time  they  were  initiated,  has  entrusted  us  with 
the  honorable  mission  of  representing  it  before  this  learned  assembly 
which,  as  in  previous  occasions,  will  solve  many  of  the  important  sani- 
tary problems  that  are  to  have  a  powerful  influence  on  the  welfare  of 
all  the  peoples  of  America. 

The  pomp  and  solemnity  with  which  the  sessions  of  the  Fifth  Inter- 
national Sanitary  Conference  are  being  inaugurated  are  evident  proofs 
of  the  support  that  this  prosperous  country  gives  to  everything  that 
means  progress  and  advancement.  May  we  be  permitted  on  this  solemn 
occasion  to  present  to  His  Excellency  Sr.  Ramon  Barros  Luco,  the 
worthy  chief  of  the  Chilean  Republic,  in  the  name  of  our  President, 
Sr.  Estrada  Cabrera,  the  fervent  vows  that  President  Barros'  per- 
sonal happiness,  and  to  tender  the  fraternal  greeting  that  Guatemala 
sends  to  the  heroic  people  of  Chile. 

Mr.  President  of  the  Conference ;  Messrs.  Delegates :  The  Delega- 
tion from  Guatemala  presents  you  their  respects,  and  wishes  you  the 
best  success  for  your  important  labors. 

The  Delegate  from  Mexico,  Dr.  Jesus  Monjaras.  Mr.  Presi- 
dent of  the  Republic;  Mr.  Minister;  Mr.  President  of  the  Conference; 
Messrs.  Delegates ;  Ladies  and  Gentlemen :     It  is  a  high  honor  and 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  23 

a  great  satisfaction  for  me  to  greet  the  people  and  the  Government 
of  Chile  in  behalf  of  the  people  and  Government  of  Mexico. 

Without  hesitating,  I  accepted  the  invitation  to  represent  my  country 
before  this  Conference,  notwithstanding  the  necessity  of  separating 
from  my  family  and  my  interests,  because  I  feel  an  immense  pleasure 
at  finding  myself  once  more  among  my  friends,  and  as  a  guest  of 
this  intelligent,  noble  and  hospitable  people  whom  I  so  love ;  and 
because  of  the  satisfaction  of  contributing  within  my  modest  ability 
to  the  realization  of  the  matters  that  are  to  be  studied  here  for  the 
purpose  of  securing  rules  for  the  uniformity  and  harmony  of  inter- 
national sanitary  measures,  thus  facilitating  the  progress  of  the  peo- 
ples constituting  this  vast  continent,  and  providing  easy  and  practical 
means  of  avoiding  the  transmission  of  infectious  diseases. 

It  is  particularly  gratifying  for  me  to  express  on  this  solemn  occa- 
sion my  sincerest  wishes  for  the  success  of  this  Conference,  for  the 
prosperity  of  this  noble  and  great  nation,  for  the  happiness  of  His 
Excellency  the  President  of  the  Republic  and  Madame  Barros  Luco, 
of  the  Delegates  here  present,  of  the  Executive  Committee,  and  of 
the  noble  and  distinguished  Chilean  ladies. 

The  Delegate  from  Panama,  Dr.  Caupolican  Pardo  Correa. 
Mr.  President  of  the  Republic ;  Mr.  President  of  the  Conference : 
Messrs.  Delegates;  Ladies  and  Gentlemen:  The  Government  of 
Panama,  a  country  which  characterized  itself  by  its  efforts  in  behalf 
of  hygiene,  stirring  on  account  of  the  advance  made  and  which  has 
placed  it  among  the  American  countries  that  have  become  prominent 
in  this  respect,  has  conferred  upon  me  the  honor  of  representing 
it  before  the  Fifth  International  Sanitary  Conference,  charging  me 
also  with  the  pleasant  duty  of  presenting  its  cordial  greetings  to  the 
Government  and  people  of  Chile,  and  to  the  Delegates  from  the  other 
Republics,  its  sincere  best  wishes  that  this  Conference  may  be  as 
useful  as  the  preceding  ones,  and  it  may  contribute  to  strengthen  the 
ties  binding  us. 

The  Delegate  from  Paraguay,  Dr.  Rogelio  Urizar.  Mr.  Presi- 
dent of  the  Republic ;  Gentlemen :  From  Paraguay,  my  country,  I 
convey  to  the  noble  and  gallant  people  of  Chile  a  cordial  greeting  of 
confraternity ;  to  the  Government  the  sentiments  of  friendship  from 
the  Paraguayan  Government;  to  the  charming  Chilean  ladies,  the  just 
admiration  of  a  people  that  knows  how  to  pay  homage  to  grace  and 
beauty;  and  in  the  persons  of  my  fellow  delegates  I  greet  the  beau- 
tiful American  continent. 

It  is  the  first  time  that  Paraguay  takes  part  in  the  International 
Sanitary  Conferences,  but  I  cherish  the  firm  conviction  that  hereafter 
its  participation  will  be  very  active,  since  its  climate  and  geographical 
situation  place  under  very  favorable  conditions  for  a  prophylactic 
campaign. 

I  could  not  but  accept  with  true  satisfaction  this  beautiful  mission 
of  confraternity  and  scientific  labor,  which  affords  me  the  opportunity 
of  becoming  acquainted  with  the  native  soil  of  my  ancestors  and  of 
meeting  the  medical  authorities  of  this  continent. 

The  important  labor  that  assembles  us  here  has  already  begun  to 
bear  fruit,  and  when  the  railroads  crossing  the  frontiers  shall  have 


24  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

at  last  united  us,  the  laws  formulated  by  these  Conferences  will  be 
the  highest  expression  of  our  culture. 

The  Delegate  from  Salvador,  Dr.  Juan  B.  Miranda.  Mr. 
Minister ;  Messrs.  Delegates ;  Gentlemen :  An  evident  sign  of  culture 
and  progress  is  this  gathering  of  scientific  men  now  assembled  here 
from  almost  all  countries  of  America  for  the  purpose  of  discussing 
and  uniforming  sanitary  principles,  to  resolve  and  adopt  hygienic 
measures  of  international  scope  calculated  to  prevent  the  propagation 
of  contagious  diseases  of  an  epidemic,  endemic,  or  pandemic  nature, 
and  to  forstall  the  deathly  damages  that  such  evils  cause  among  the 
inhabitants  of  this  continent,  for  which  a  brilliant  future  is  in  reserve. 
Nobly  contributing  to  the  realization  of  these  beautiful  ideals  of 
altruism,  a  civilizing  task  is  performed,  and  the  interests  of  the  great 
human  family  are  best  served. 

In  keeping  with  these  noble  and  lofty  purposes  is  the  honor  that 
has  been  conferred  upon  me  by  the  Government  of  the  Republic  of 
El  Salvador,  designating  me  as  its  Delegate  to  the  Fifth  International 
Sanitary  Conference  of  the  American  Republics.  To  all  this  and  to 
his  personal  qualifications  is  due  the  marked  interest  which  the  Presi- 
dent of  Salvador,  Dr.  Manuel  Enrique  Araujo,  takes  in  this  assembly 
and  hopes  for  its  success,  he,  himself,  being  a  most  distinguished 
physician  and  a  thorough  Central-American.  Not  only  does  President 
Araujo  bind  his  warm  affection  to  the  happiness  of  the  nation  over 
which  he  presides,  but  also  to  the  welfare  of  Central  America,  of 
that  of  the  New  World,  which  may  be  considered  as  the  common 
fatherland  of  all  those  who  have  had  the  honor  of  being  born  on 
American  soil. 

The  Government  of  Salvador  adheres  to  the  resolutions  passed  by 
previous  Sanitary  Conferences ;  it  will  adhere  to  such  amendments, 
changes  or  revisions  that  may  be  made  thereto,  and  it  will  also 
adhere  to  the  new  resolutions  that  are  to  be  adopted  by  this  Con- 
ference. It  shall  lend  its  loyal  support  to  everything  that  may  be 
resolved,  and  shall  not  omit  any  sacrifice  that  may  be  needed  in  order 
to  carry  out  efficiently  all  sanitary  measures  for  the  preservation  and 
welfare  of  humanity. 

Therefore,  in  the  name  of  the  Government  of  Salvador,  I  have  the 
honor  to  perform  a  triple  mission :  First,  to  present  my  respectful 
homage  to  His  Excellency  the  President  of  Chile  for  the  high 
patronage  to  this  assembly  of  public  hygiene ;  second,  to  congratulate 
and  applaud  the  President  of  the  Conference,  Dr.  A.  del  Rio,  and 
through  his  medium,  all  the  members  of  the  Chilean  Delegation  for 
the  efforts  they  have  displayed  to  secure  the  success  of  the  Confer- 
ence ;  and,  third,  to  send  a  cordial  and  affectionate  greeting  of  pro- 
fessional comradeship  and  solidarity  to  all  my  distinguished  fellow- 
delegates. 

The  Delegate  from  Uruguay,  Dr.  Ernesto  Fernandez  Espiro. 
Mr.  President  of  the  Republic ;  Mr.  Minister  for  Foreign  Affairs ;  Mr. 
President  of  the  Fifth  International  Sanitary  Conference :  In  the  first 
,  place,  the  Uruguayan  Delegation  thanks  the  Chilean  Government  for 
the  kind  attentions  extended  to  us  from  the  moment  we  arrived  at 
the  beautiful  land  of  a  traditional  culture. 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  25 

The  participation  of  Uruguay  in  past  Conferences,  and  the  interest 
showed  therein  by  its  sanitary  authorities  and  those  devoted  to  the 
study  of  hygiene,  account  sufficiently  for  its  alherence  to  the  pur- 
poses of  this  new  Conference  and  its  representation  before  it. 

For  us,  who  fulfill  the  pleasant  mission  of  conveying  to  the  Govern- 
ment of  this  country  the  affectionate  greetings  of  the  Uruguayan 
Government  and  our  best  friendly  wishes,  it  is  a  source  of  true 
satisfaction  to  attend  this  Conference,  which  enjoys  the  fortune  of 
gathering  the  representatives  from  almost  all  the  American  Republics. 
Its  success,  which  may  already  be  assured,  shall  confirm  once  more 
the  good  results  of  this  periodic  meeting  and  shall  justify,  at  the  same 
time,  the  advisability  of  continuing  them  and  of  securing  for  the 
future  the  attendance  of  all  American  countries,  because  everyone  of 
them  should  be  equally  interested  in  the  deliberations  of  these  Con- 
ferences and  the  enforcement  of  their  resolutions. 

Gentlemen,  Uruguay  contributes  to  this  meeting  with  the  work 
which  it  has  carried  out  with  regard  to  sanitation  during  the  last 
few  years,  and  although  it  does  not  pretend  to  have  solved  all  the 
problems  of  sanitary  science,  it  is  in  a  position  to  say  that  it  has 
found  a  solution  for  many  of  them,  and  it  will  find  it  for  other 
problems,  since  that  is  the  aim  of  the  Government  and  authorities  of 
the  Republic.  The  Uruguayan  Delegation  will  have  occasion  during 
this  Conference  to  dwell  further  on  its  report  and  to  explain  the 
organization  and  operation  of  the  sanitary  services  of  the  Republic 
and  the  enforcement  of  the  recommendations  of  previous  Conferences. 

Meanwhile,  it  predicts  that  this  new  meeting  will  have  the  best 
results,  thanks  to  the  ability  and  learning  of  our  colleagues  of  this 
country  and  of  the  other  Republics  here  represented. 

The  Delegate  from  Venezuela,  Dr.  Pablo  Acosta  Ortiz.  Mr. 
President  of  the  Republic;  Mr.  President  of  the  Conference:  We, 
the  Delegates  from  Venezuela,  in  fulfilling  the  mission  which  has  been 
entrusted  to  us,  perform  the  duty  of  presenting,  in  the  name  of  our 
Government,  a  cordial  greeting  to  the  Government  of  Chile,  and  our 
warmest  wishes  for  the  prosperity  and  aggrandizement  of  the  great 
Chilean  nation,  which  now  extends  to  us  its  courteous  hospitality, 
offering  us  the  best  bread  from  its  granaries  and  the  best  wine  from 
its  vineyards. 

The  honor  has  been  conferred  on  us  again  of  forming  part  of  this 
Conference,  whose  high  deliberations  tend  to  make  the  conquests  of 
modern  sanitary  science  uniform  and  practicable,  and  upon  congratu- 
lating ourselves  and  our  colleagues  we  trust  that  the  definite  resolu- 
tions of  this  Conference  shall  take  mutual  respect  as  the  standard, 
and  shall  be  inspired  from  equity  and  justice,  the  only  elements  which 
render  friendship  permanent  and  sincere,  and  which  make  strong  and 
closer  the  ties  binding  the  American  nations. 


SECOND  DAY— MONDAY,  NOVEMBER  6,  1911. 
Morning  Session. 

The  session  was  called  to  order  at  10:30  A.  M.,  the  Provisional 
President,  Dr.  Alejandro  del  Rio,  presiding,  all  the  foreign  Delegates 
being  present  and  nearly  all  the  members  of  the  Chilean  Delgation. 

The  Provisional  President.  In  accordance  with  the  program, 
this  session  is  for  the  object,  in  the  first  place,  of  electing  the  President 
of  the  Conference.  By  designation  of  the  Supreme  Government,  it 
has  been  my  honor  until  this  moment  to  have  charge  of  the  work,  in 
lieu  of  our  bereaved  and  beloved  President  of  the  Supreme  Council 
of  Hygiene,  Dr.  Maximo  Cienfuegos. 

It  would  be  gratifying  for  me  to  surrender  these  high  duties,  be- 
cause there  are  in  this  Conference  distinguished  personalities  with 
greater  merits  than  mine. 

Dr.  Araoz  Alfaro.  In  the  name  of  the  Argentine  Delegation,  and 
believing  that  I  am  also  interpreting  the  wishes  of  the  other  Delega- 
tions here  present,  I  move  that  a  vote  of  applause  be  given  to  the 
executive  committee  for  its  wonderful  organization  of  this  Conference. 
And  to  signify  this  vote,  I  ask  all  Delegates  to  rise.  (The  motion 
was  unanimously  carried  and  all  the  Delegates  rose.) 

I  also  move  that  Dr.  Alejandro  del  Rio  be  made  the  permanent 
President  of  the  Fifth  Conference.  Nobody  better  than  he,  who 
has  been  the  organizer  of  the  preliminary  work,  could  discharge  the 
position  with  greater  efficiency.  This  motion  is  also  made  to  include 
the  confirmation  of  Dr.  Amunategui  as  Secretary  and  the  other  Dele- 
gates as  members  of  the  Executive  Committee. 

(This  motion  was  carried  by  acclamation.) 

Dr.  Fernandez  Espiro.  I  move  that  the  Conference  pay  a  tribute 
to  the  memory  of  the  eminent  Dr.  Cienfuegos,  elected  President  of  this 
Conference,  and  to  this  end  I  have  the  honor  to  propose  that  the 
Delegates  rise  in  homage  to  our  bereaved  colleague.  (The  motion 
was  carried  by  acclamation  and  the  Delegates  rose.) 

The  President.  I  thank  the  Delegates  most  expressively  for  the 
high  honor  they  have  conferred  upon  me  by  electing  me  as  the  Presi- 
dent of  this  Conference.  I  must  now  refer  to  a  slight  irregularity 
that  might  perhaps  affect  the  resolutions  we  may  pass  now,  although 
such  an  irregularity  is  only  a  matter  of  form. 

The  credentials  presented  by  the  Delegates  were  delivered  last 
Saturday  to  the  Under-Secretary  for  Foreign  Affairs,  who  will  return 
them  in  a  short  while  to  have  them  referred  to  the  special  committee 
that  is  to  be  appointed  for  the  purpose  of  passing  upon  them.  There- 
fore, we  will  not  be  definitely  constituted  at  this  session.  At  this 
afternoon's  session  we  may  give  approval  to  our  actions  at  this 
session. 

It  is  now  in  order  to  elect  the  Secretary. 

Dr.  Oliver.     Dr.   Araoz  Alfaro  already  made  a  motion  to  that, 


FIFTH    INTERNATIONAL  SANITARY  CONFERENCE.  27 

which  was  carried.  This  being  the  case,  I  think  it  is  not  necessary 
to  vote  again.  On  the  other,  nobody  better  than  the  provisional  Secre- 
tary could  perform  those  duties,  because  the  transactions  and  all 
documents  must  remain  here.  If  necessary,  I  make  a  formal  motion 
to  confirm  Dr.  Amunategui  in  that  position. 

The  President.  If  all  the  Delegates  agree,  the  proposition  of  the 
Uruguayan  Delegate  will  be  carried.  (General  acceptance,  and  Dr. 
Amunategui  then  takes  possession  of  his  seat  as  Secretary.) 

The  Secretary,  Dr.  Amunategui.  I  beg  leave  to  thank  my  dis- 
tinguished colleagues  most  sincerely  for  the  honor  they  have  bestowed 
upon  me.  At  the  same  time,  I  request  the  President  to  move  that 
one  more  Secretary  be  appointed,  who  should  be  one  of  the  foreign 
Delegates,  as  has  been  customary.  I  take  the  liberty  to  submit  the 
name  of  Dr.  Razetti,  who  filled  the  same  position  in  the  last  Confer- 
ence. (The  proposition  of  Dr.  Amunategui  was  carried  by  acclama- 
tion, and  Dr.  Razetti  took  a  seat  at  the  President's  table,  and  thanked 
the  Conference.) 

Dr.  Fernandez  Espiro.  With  regard  to  the  designation  of  Vice- 
Presidents,  the  rule  followed  in  previous  Conferences  has  been  to 
elect  as  such  all  the  Delegates  who  had  attended.  If  this  procedure 
is  acceptable,  I  would  move  that  it  be  followed  also  on  this  occasion. 

The  President.  The  list  of  Delegates  will  be  read  in  case  there 
is  any  remark  to  be  made.  With  regard  to  the  proposition  of  the 
Delegate  from  Uruguay,  I  think  it  is  well  to  remember  that  several 
Delegations  are  composed  of  more  than  one  member.  If  the  assembly 
deem  it  advisable,  in  such  cases  only  one  of  the  members  should  be 
designated  as  Vice-President. 

(The  motion  of  Dr.  Fernandez  Espiro,  with  the  amendment  sug- 
gested by  the  President,  was  carried  unanimously.) 

The  Secretary,  Dr.  Amunategui,  then  read  the  list  of  Delegates 
which  appears  on  page  5.  He  afterwards  announced  that  Dr.  Igle- 
sias,  Delegate  from  Costa  Rica,  and  Dr.  Valenzuela  Valdes,  of  Hon- 
duras, had  not  yet  arrived. 

Dr.  Vial.  As  a  Delegate  from  Chile  to  the  last  Conference,  and 
therefore  in  a  position  to  know  the  procedure  followed  on  former 
occasions,  I  move  that  a  third  secretary  be  appointed,  who  should  be 
a  member  of  the  United  States  Delegation.  I  propose  that  Dr.  James 
Perry  be  appointed  as  such.  (The  motion  was  unanimously 
carried.) 

The  President.  In  view  of  the  decision  of  the  Conference,  Dr. 
Perry  is  also  designated  as  Secretary.  There  will  now  be  read  the 
list  of  Delegates  whose  names  are  submitted  as  Vice-Presidents  of  the 
Conference.  (The  list  was  read  and  the  Delegates  named  elected  as 
Vice-Presidents  by  unanimous  vote.) 

The  President.  It  is  now  in  order  to  appoint  the  various  com- 
mittees. The  Secretary  will  read  a  list  that  has  been  prepared  for 
submission  to  the  Conference.  I  request  the  Delegates  to  make  such 
remarks  as  they  may  deem  proper. 

The  Secretary,  Dr.  Amunategui,  read  the  list  referred  to,  which 
appears  on  page  — ,  as  subsequently  modified. 

Dr.   Fernandez   Espiro.     I  have  no   remark  to  make  to  the  list 


28  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

as  read,  with  the  exception  that  the  President  of  the  Conference  be 
added  to  the  Executive  Committee.  (This  motion  was  unanimously 
carried.) 

Dr.  Ferrer.  I  would  that  the  assembly  appoint  a  committee  of 
three  or  four  Delegates  to  study  the  list  just  read  and  in  this  after- 
noon's session  to  recommend  the  addition  of  such  names  as  were 
not  included — perhaps  on  account  of  lack  of  time — and  who  it  may 
be  advisable  to  appoint  on  account  of  their  particular  specialities. 

Dr.  Fernandez  Espiro.  The  just  desire  manifested  by  the  Dele- 
gate from  Chile  might  be  well  met  in  this  manner:  That  each  com- 
mittee, by  its  own  action,  should  be  enabled  to  decide  which  other 
members  of  the  Conference  might  be  added  to  it. 

Dr.  Vicencio.  Perhaps  it  would  be  more  advisable  to  let  the 
Delegates  join  whichever  committees  they  might  be  more  interested  in. 

Dr.  Ferrer.  T  believe  that  Dr.  Fernandez  Espiro's  suggestion 
meets  the  difficulty  better.  I  accept  it,  so  far  as  I  am  concerned,  and 
withdraw  my  motion. 

Dr.  Vicencio.  This  matter  might  go  over  until  this  afternoon's 
session,  and  the  committees  as  proposed  by  the  President  could  be 
appointed  now. 

Dr.  Alfonso.  Both  propositions  are  compatible,  so,  I  think,  the 
two  could  be  accepted. 

Dr.  Araoz  Alfaro.  The  motion  of  the  Delegate  from  Uruguay 
is  conciliatory,  and  could  be  accepted  right  now. 

(The  motion  of  Dr.  Fernandez  Espiro  was  carried  unanimously.) 

The  President.     The  program  of  this  session  is  complete. 

The  session  adjourned  at  12  M. 

Afternoon  Session. 

The  session  was  called  to  order  by  the  President,  nearly  all  the 
Delegates  being  present.  With  the  President  sat  Dr.  Araoz  Alfaro, 
of  the  Argentine  Republic,  and  Dr.  Sanjines,  of  Bolivia,  in  their 
capacity  as  Vice-Presidents  of  the  Conference. 

The  minutes  of  the  morning  session  were  read  and  approved. 

The  President.  We  should  begin  our  labors  with  the  reading  of 
the  reports  of  the  various  Delegates.  Following  the  alphabetical 
order,  the  first  place  belongs  to  the  Argentine  Delegation.  Dr.  Al- 
varez has  the  floor. 

Dr.  Alvarez.  The  delegation  of  which  I  am  a  member  has  pre- 
pared four  reports,  which  it  has  the  honor  of  presenting  to  the  Con- 
ference. One  deals  with  the  defense  against  cholera ;  another  with 
plague ;  another  with  the  campaign  against  malaria  in  the  Argentine 
Republic,  and  the  fourth  one  with  compulsory  vaccination. 

Dr.  Monjaras.  I  deem  it  advisable  that  the  order  established 
by  the  program  should  be  followed.  In  this  respect,  in  my  opinion, 
we  should  begin  with  the  first  subject  of  the  program,  which  refers 
to  "the  laws  of  sanitary  police  and  sanitation  measures  adopted  in 
each  country  since  the  Fourth  Sanitary  Conference,"  and  then  continue 
with  the  other  subjects  in  their  proper  order.  Afterwards,  the  report 
should  be  open  for  discussion. 

Dr.  Guiteras.     I  agree  with  the  Delegate  from  Mexico  as  to  the 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  29 

enforcement  of  the  order  established  by  the  program.  But  I  was 
also  under  the  impression,  or  at  least  such  is  the  interpretation  given 
by  the  American  Delegation,  that  each  Delegation  should  present  a 
resume  or  abstract,  destined  to  explain  to  the  Conference  the  manner 
in  which  the  resolutions  adopted  in  former  Conferences  have  been 
complied  with,  and  that  afterwards  the  reports  on  the  special  subjects 
included  in  the  program  would  be  read. 

Dr.  Monjaras.  The  subject  referred  to  by  the  American  Delegate 
is  included  in  the  program,  but  it  is  the  second  thereon  and  not  the 
first.  It  is  true  that  the  program  that  has  been  distributed  among 
us  is  merely  provisional,  but  it  must  be  followed  until  a  permanent 
one  be  adopted. 

Dr.  Araoz  Alfaro.  The  Delegation  of  which  I  am  a  member  has 
not  been  able  to  bring  a  general  resume  because  this  is  the  first  time 
that  the  Argentine  Republic  takes  part  in  these  Conferences;  but 
instead,  it  presents  various  papers  on  special  subjects  included  in  the 
program.  As  to  precedence  for  the  consideration  of  subjects,  that  the 
Delegate  from  Mexico  thinks  is  prescribed  by  the  regulation  of  the 
Conference,  I  understand  that  there  is  no  calendar  compelling  the 
assembly  to  postpone  one  subject  for  another  one.  If  my  under- 
standing is  correct,  as  I  think  it  is,  I  will  say  that  we  are  at  liberty 
to  take  up  several  subjects  in  such  order  as  may  seem  to  us  most 
advisable,  or  only  a  few  of  them  and  not  all. 

In  this  particular,  the  Argentine  Delegation  places  itself  entirely 
at  the  command  of  the  assembly.  Therefore,  if  the  Conference  re- 
solves to  take  up  the  resumes,  this  Delegation  will  gladly  postpone 
the  presentation  of  its  report  until  such  time  as  may  be  set  therefor. 

Dr.  Razzetti.  We  should  bear  in  mind  the  second  recommenda- 
tion attached  to  the  provisional  program,  which  is  as  follows : 

2.  Each  delegation  shall  present  a  paper  or  report  which  shall  deal  precisely 
and  necessarily  with  the  sbject  marked  out  in  this  program,  and  also  a  concise 
extract  of  the  same  to  be  read  within  fifteen  minutes'  time  at  the  sessions.  Each 
extract  shall  be  printed  in  Spanish  and  English;  that  of  Brazil  in  Portuguese 
and  English,  and  that  of  Hayti  in  French  and  English. 

Therefore,  when  for  the  present  session  the  reading  is  announced 
of  the  reports  of  each  Delegation,  it  is  meant,  of  course,  that  the 
assembly  will  hear  and  consider  extracts  or  resumes  and  not  the 
report  in  full,  whose  reading  could  not  be  made  in  the  space  of  fifteen 
minutes. 

Dr.  Araoz  Alfaro.  I  repeat  that  the  subjects  included  in  the 
reports  of  the  Argentine  Delegation  are  in  accord  with  the  provisions 
of  the  program  announced  for  this  Conference.  Therefore,  the  only 
thing  to  be  decided  upon  is  whether  the  papers  that  we  have  prepared 
should  be  taken  up  at  this  session  or  at  another  one. 

Dr.  da  Rocha.  Acknowledging  that  the  Delegate  from  Mexico 
is  perfectly  right  in  his  remarks,  and  that  the  Delegate  from  Vene- 
zuela has  properly  and  pertinently  reminded  us  of  an  important  point, 
at  the  same  time,  I  think  that  the  Argentine  Delegates  have  complied 
with  their  mission  most  fully,  because  their  papers  are  strictly  con- 
fined to  the  subjects  assigned  to  this  Conference. 


30  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

Dr.  Fernandez  Espiro.  I  agree  with  Dr.  Monjaras'  view  that 
in  the  absence  of  a  resolution  to  the  contrary,  which  has  not  been 
passed,  the  Conference  should  proceed  in  accordance  with  the  provi- 
sional program.  But  there  is  a  decisive  circumstance  for  not  strictly 
applying  the  regulations  on  this  occasion.  This  circumstance  has  been 
invoked  and  deserves  the  consideration  of  the  Conference.  Dr.  Araoz 
Alfaro  has  said  that  this  is  the  first  time  that  the  Argentine  Republic 
participates  in  these  Conferences,  and,  for  this  reason,  its  Delegates 
can  plausibly  disregard  the  practice  heretofore  observed  and  the 
existence  of  a  program  previously  adopted.  Those  of  us  who  have 
attended  former  Conferences  have  borne  in  mind  this  antecedent,  and 
for  this  reason  the  Uruguayan  Delegation  has  dealt  with  most  of  the 
subjects  prescribed,  and  has  also  made  an  extract  of  its  reports  so 
that  their  reading  may  be  limited  to  the  time  allowed.  But  the  posi- 
tion of  the  Argentine  Delegates  is  different,  and  it  seems  to  me  that 
the  Conference  could  not  dispense  with  the  reading  of  the  reports 
they  have  prepared.  As  an  act  of  courtesy,  I  would  move  that  the 
Argentine  Delegates  be  given  the  floor  so  that  they  may  read  their 
report. 

Dr.  Sanjines.  The  Bolivian  Delegation  finds  itself  in  the  same 
position  as  the  Argentine  Delegation. 

Dr.  Soza.  At  a  former  Conference,  in  which  I  was  present,  there 
was,  as  in  this  Conference,  a  provisional  program  indicating  the  sub- 
jects. The  permanent  program  is  adopted  by  the  Conference,  if  it 
so  deems  advisable. 

Dr.  Araoz  Alfaro.  The  reports  of  the  Argentine  Delegation 
might  be  taken  up  after  the  other  Delegations  have  read  the  extracts 
they  have  made.  The  Argentine  Delegation  would  be  pleased  to  see 
this  procedure  adopted. 

Dr.  Ferrer.  In  previous  Conferences,  the  strict  compliance  with 
the  provisional  program  was  not  required.  It  is  sufficient  to  glance 
at  the  transactions  of  those  Conferences  to  see  that  a  great  number 
of  the  papers  read  were  not  adapted  to  the  previous  established 
previously.  Sometimes  a  report  included  all  the  subjects,  and  other 
reports  included  only  one  or  some  of  the  subjects.  This  procedure 
may  not  be  quite  regular,  but  for  obvious  reasons  it  should  not  com- 
pletely be  proscribed. 

Dr.  Fernandez  Espiro.  I  think  the  point  raised  has  been  suffi- 
ciently discussed,  and  I  believe  that  the  incident  could  be  closed  to  the 
satisfaction  of  all  if  we  adopt  the  following  motion  which  I  submit 
to  the  Conference: 

The  Delegations  of  the  different  countries  participating  in  this  Conference 
are  allowed  to  read  their  reports  even  if  they  are  not  strictly  in  accord  with 
the  regulations  of  the  Conference. 

(A  vote  was  taken  and  the  motion  unanimously  carried.) 
The  President.  I  wish  to  ask  the  Conference  a  question.  As 
I  believe  to  have  understood  it,  the  Mexican  Delegate  opines  that  the 
subjects  should  be  taken  up  independently  and  separately.  That  is 
to  say,  that  each  Delegation  will  be  given  the  floor  to  deal  with  the 
first  subject  only. 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  31 

Several  Delegates.  No,  Mr.  President,  there  should  be  no 
limitation. 

The  President.  Very  well.  I  will  then  give  the  floor  to  each  Dele- 
gation to  read  its  report,  whether  it  be  complete  or  not. 

Dr.  Monjaras.  I  will  give  the  President  the  explanation  he  de- 
sires. If  the  complete  reports  are  long,  the  Delegates  should  read 
extracts,  the  reading  of  which  shall  not  take  up  more  than  fifteen  min- 
utes. When  the  fifteen  minutes  are  up,  the  President  should  grant  the 
floor  to  another  Delegate.  This,  I  think,  is  the  order  which  should 
be  followed. 

The  President.  As  the  regulations  and  the  program  are  only  of 
a  provisional  nature,  I  request  the  assembly,  if  it  should  deem  it  ad- 
visable, to  give  them  a  permanent  status. 

(This  motion  was  unanimously  carried.) 

The  President.    Dr.  Alvarez  has  the  floor. 

Dr.  Alvarez  read  the  report  which  appears  on  page  77  of  the  Ap- 
pendix. 

(On  motion  of  Dr.  Fernandez  Espiro  the  Argentine  Delegation  was 
allowed  additional  time  to  proceed  with  its  interesting  reports.) 

(Another  report  of  the  Argentine  Delegation,  on  compulsory  vac- 
cination was  left  over  for  a  subsequent  session.) 

The  President.  I  would  like  to  know  if  the  Conference  wishes  to 
take  up  the  immediate  discussion  of  each  report,  or  if  it  prefers  to 
leave  it  until  after  all  the  reports  have  been  read.  I  move  that  the 
latter  procedure  be  adopted,  because  it  offers  the  advantage  of  taking 
up  the  discussion  of  a  certain  subject — malaria,  for  instance — after  all 
the  reports  thereof  have  been  heard. 

(This  motion  was  carried,  and,  consequently,  the  discussion  was 
postponed  until  the  reading  of  the  reports  was  over.) 

Dr.  Roberts.  Dr.  Alvarez,  in  his  report  on  cholera,  stated  that 
there  is  in  the  Argentine  Republic  a  corps  of  bacteriologists,  and  that 
a  suspected  ship  arrives  the  examination  of  the  individual  is  made. 
That  examination,  as  I  understand,  is  made  during  the  trip  and  also 
upon  arrival  at  port.  I  wish  to  know  if  the  physicians  who  make  the 
examination  on  board  ship  are  employed  by  the  Argentine  Govern- 
ment or  by  the  respective  navigation  company. 

Dr.  Alvarez.    They  are  employed  by  the  Argentine  Government. 

Dr.  Monjaras.  I  would  like  to  know  what  do  the  bacteriological 
examinations  on  board  consist  of.  It  is  important  to  know  if  they  are 
bacterioscopical  examinations  of  the  baccilu,  or  if  the  examination  of 
agglutination  is  made. 

Dr.  Araoz  Alfaro.    They  include  both  things. 

Dr.  Alvarez.  I  am  at  the  disposal  of  Dr.  Monjaras  to  furnish  him 
the  details  regarding  the  examinations. 

Dr.  Araoz  Alfaro.  I  will  advance  the  information  that  all  neces- 
sary means  are  employed  in  order  to  reach  a  diagnosis  as  rapidly  as 
possible. 

The  President.    The  Delegate  from  Bolivia  has  the  floor. 

Dr.  Sanjines  read  the  report  given  on  page  81  of  the  Appendix. 

Dr.  Guiteras.  I  would  like  to  know  what  disease  is  that  upon 
which  the  Delegate  from  Bolivia  has  reported  under  the  name  of 
espundia. 


32  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

Dr.  Sanjines.  It  is  Briebas  bubo.  Concerning  this  disease  and  its 
treatment,  I  will  say  that  I  have  treated  with  success  some  cases  of 
espundia  in  the  legs,  by  means  of  rasping  and  cauterization.  Those 
afflicted  with  espundia  in  the  fauces  generally  die  of  tuberculosis.  At 
present  there  are  two  physicians  in  Bolivia  who  employed  the  606  in- 
jections in  the  sections  of  the  country  infested  with  this  disease.  Ac- 
cording to  the  reports  they  have  sent  to  the  Government  they  obtain 
saisfactorily  results  with  this  treatment,  except  in  causes  where  the 
fauces  are  affected.  I  myself  have  employed  the  same  injections  with 
similar  results. 

Dr.  Razetti.  In  Venezuela  we  have  recently  began  to  experiment 
the  606  injection  with  the  same  purpose.  A  soldier  who  had  been 
subjected  to  the  treatment  improved  within  12  hours.  In  another  case 
the  eruption  disappeared  immediately  after  the  first  injection. 

Dr.  Urizar.  In  Paraguay  this  disease,  there  known  as  buba,  oc- 
curs under  some  peculiar  symptoms,  and  with  no  little  frequency  it 
appears  in  the  northern  verba  mate  groves  and  in  the  Brazilian  rub- 
ber plantations,  bordering  with  the  Oriental  regions  of  Bolivia.  As 
a  general  rule,  the  disease  begins  by  affecting  the  hand  or  the  foot, 
through  the  bite  of  ticks,  flies  and  other  insects  and  worms,  and  is 
then  manifested  by  ulcerations  with  fleshy  irregular  borders,  of  the 
size  of  a  dollar.  Many  patients  are  cured  by  cauterization,  or  rasp- 
ing followed  by  cauterization.  In  obstinate  cases,  after  a  period  vary- 
ing between  three  and  four  months,  the  disease  attacks  the  soft  palate 
or  the  nasal  fossae.  It  is  the  stage  of  specific  localization,  which  follows 
that  of  generalization.  This  stage  of  generalization  is  a  rule  short 
and  irregular.  In  some  cases  it  is  manifested  by  symptoms  common 
to  septicaemia.  In  other  cases  those  symptoms  are  accompanied  by 
the  apparition  of  ulcerations  in  different  parts  of  the  body ;  these  latter 
symptoms  I  know  only  from  what  I  have  read  of  them  in  descriptions 
of  the  disease  written  by  Argentine,  Bolivian  and  Brazilian  authors. 
Of  cases  that  have  come  under  my  observation,  none  have  shown  other 
localizations  than  those  in  the  nose  and  the  soft  palate.  As  to  the  na- 
ture of  the  disease,  I  do  not  agree  with  the  opinion  of  the  Bolivian 
Delegate.  I  have  colored  a  great  many  preparations,  I  have  innocu- 
lated  various  species  and  cultivated  in  several  forms,  and  I  think  I  have 
the  assurance  that  it  is  not  tuberculosis,  as  Dr.  Sanjines  opines,  but  a 
disease  due  to  an  infection  whose  agent  is  still  unknown  and  which  is 
probably  transmitted  through  insects  which  bite  men  in  those  regions 
(ticks  and  bot-flies). 

The  President.    The  Delegate  from  Brazil  has  the  floor. 

Dr.  da  Rocha.  In  behalf  of  the  Brazilian  Delegation,  I  submit  to 
the  Conference  several  printed  volumes,  to  wit:  Historical  sketch  of 
the  public  health  services  of  j  Brazil,  specially  in  the  city  of  Rio  Janeiro, 
during  the  century  1808-1909;  Sanitary  laws  and  regulations  in  force 
in  Brazil,  Medical  emergency  service  in  Rio  Janeiro ;  Yearbook  of 
demographic-sanitary  Statistics,  published  in  1910  by  Dr.  Casio  Ra- 
zende,  of  the  General  Bureau  of  Public  Health ;  and  the  Commemora- 
tive Bulletin  of  the  National  Exposition  of  1908.  (Dr.  da  Rocha  then 
read  the  report  appearing  on  page  87  of  the  Appendix.) 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  33 

Dr.  Araoz  Alfaro.  On  behalf  of  the  Argentine  Delegation  I  wish 
to  congratulate  the  Brazilian  Delegation  for  the  splendid  work  it  has 
presented,  which  includes  all  the  subjects  of  the  program.  At  the  same 
time,  and  although  the  Brazilian  Government  has  already  been  con- 
gratulated for  the  sanitary  works  done,  especially  in  Rio  de  Janeiro, 
thanks  to  which  yellow  fever  has  been  eradicated,  I  would  ask  my  es- 
teemed colleagues  to  send  again  a  vote  of  applause  to  that  Govern- 
ment, I  would  also  move  that  the  Conference  adopt  a  vote  to  place  the 
Brazilian  physician  Dr.  Oswaldo  Cruz  among  the  benefactors  of  hu- 
manity.    (Unanimous  demonstrations  of  acceptance.) 

Dr.  Monjaras.  Being  acquainted  with  Dr.  Oswaldo  Cruz's  work, 
I  wish  that  it  be  expressly  stated  in  the  minutes  that  the  Mexican  Dele- 
gation adheres  to  the  vote  proposed  by  the  Argentine  Delegation. 

Dr.  da  Rocha.  I  request  that  special  mention  be  made  in  the  min- 
utes of  the  deep  appreciation  of  the  Brazilian  Delegation  for  this 
courteous  and  honoring  manifestations  addressed  to  our  Government 
and  one  of  the  most  eminent  men  of  our  nation. 

Dr.  Maira.  I  have  been  requested  by  the  Director  of  the  Sismo- 
logical  Institute,  don  Fernando  Montesus  de  Ballore,  to  invite  the  Del- 
egates to  visit  the  Santa  Lucia  Observatory. 

(The  session  adjourned.) 


THIRD  DAY— TUESDAY,  NOVEMBER  7,  1911. 
Afternoon  Session. 

The  Conference  was  called  to  order  by  the  President  Dr.  Alejandro 
del  Rio,  nearly  all  the  Delegates  being  present.  By  invitation  of  the 
President,  Dr.  da  Rocha,  of  Brazil,  and  Dr.  Vicencio,  of  Columbia, 
sat  at  the  presidential  table  in  their  capacity  as  Vice-Presidents  of  the 
Conference. 

The  minutes  of  the  previous  session  were  read  and  approved. 

Dr.  da  Rocha  submitted  to  the  Conference  a  map  of  Brazil  show- 
ing the  sanitary  ports  of  the  Republic. 

The  President.  Gentlemen,  I  have  the  honor  to  introduce  to  you 
the  distinguished  representation  of  the  Pan-American  Union,  Captain 
Granville  R.  Fortescue,  who  honors  us  with  his  presence.  I  move  that 
he  be  admitted  to  the  sessions.  He  will  deliver  in  due  time  a  greeting 
from  the  Pan-American  Union,  of  which  he  is  the  bearer. 

(The  motion  of  the  President  was  unanimously  approved.) 

The  President.  I  also  have  the  honor  to  introduce  to  you  the  hon- 
orable Delegate  from  Costa  Rica,  Dr.  Fernando  Iglesias,  who,  on  ac- 
count of  difficulties  in  the  transportation,  was  delayed  in  his  arrival. 
The  ^Delegate  from  Costa  Rica  has  the  floor  to  deliver  the  greeting 
from  his  country. 

Dr.  Iglesias.  Gentlemen:  It  is  an  honor  and  a  sincere  pleasure 
for  me  to  send  a  warm  greeting  to  the  Government  and  the  medical 
profession  of  Chile.  I  come  to  this  hospitable  and  generous  land  full 
of  faith  and  gratifying  hopes.  Now  that  I  find  myself  in  the  midst  of 
this  vigorous  people,  which  is  justly  proud  of  having  produced  so 
many  eminent  men  and  illustrious  physicians,  my  admiration  for  it 
increases.  Debts  of  gratitude  bind  us  to  the  Chilean  Nation.  Costa 
Rica  does  not  forget  them.     In  the  name  of  my  country  I  greet  you. 

Dr.  Iglesias,  Dr.  Roberts,  Dr.  Cornejo,  Dr.  Guiteras,  Dr.  Bian- 
chi,  and  Dr.  Monjaras  read  their  respective  reports,  in  the  order 
named  (see  the  Appendix,  pages  97,  101,  107,  121,  113,  and  115,  re- 
spectively). 

The  President.  A  new  list  of  the  Committees  has  been  drawn  up. 
The  changes  made  in  the  list  previously  approved  consist  merely  of 
the  addition  of  new  members  to  some  committees. 

The  Secretary,  Dr.  Amunategui.  The  Committees,  with  the  new 
members,  are  now  constituted  as  follows.     (See  page  6.) 

Dt.  Guiteras.  If  I  remember  rightly,  a  Committee  on  Resolutions 
was  appointed  for  the  purpose  of  considering  the  different  motions 
presented  before  submitting  them  to  the  Conference.  I  would  like 
to  know  if  these  functions  are  to  be  exercised  by  the  Executive  Com- 
mittee. 

Several  Delegates.    Yes,  sir. 

The  President.  It  is  understood  that  the  consideration  of  the  mo- 
tions is  to  be  made  by  the  Executive  Committee. 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  35 

Dr.  Araoz  Alfaro.  It  seems  advisable  that  such  reports  as  have 
been  read  be  referred  to  the  Executive  Committee,  so  that  it  may  in 
turn  assign  them  to  the  proper  committees. 

The  President.  Are  the  reports  to  be  submitted  also,  or  only  the 
motions?  I  believe  that  the  consideration  of  the  reports  would  take 
too  much  of  the  Executive  Committee's  time,  and  it  may  even  be  im- 
possible. The  chair  would  ask  the  Delegates  having  motions  to  sub- 
mit, to  send  them  in  written  form  to  the  secretary. 

Several  Delegates.    Very  well,  we  shall  do  so. 

The  President.  It  is  then  agreed  that  the  Delegates  will  present 
the  motions  in  the  exact  form  in  which  would  have  the  Conference 
adopt  them. 

The  committees  will  be  called  to-morrow  so  that  they  may  begin 
their  labors. 

(The  session  adjourned  at  5.15  p.  m.) 


FOURTH   DAY— WEDNESDAY,   NOVEMBER  8,   1911. 
Afternoon  Session. 

The  Conference  was  called  to  order  by  the  President  at  2  P.  M., 
nearly  all  the  Delegates  being  present.  By  request  of  the  President, 
Dr.  Iglesias,  of  Costa  Rica,  and  Dr.  Roberts,  of  Cuba,  sat  at  the 
presidential  desk  in  their  capacity  as  Vice-Presidents  of  the  Confer- 
ence. 

The  minutes  of  the  previous  session  were  read  and  approved. 

The  President.  Yesterday,  late  in  the  evening,  Dr.  Jose  R.  Campos 
and  Sefior  Tito  V.  Lizoni,  received  the  credentials  accrediting  them  as 
Delegates  from  the  Dominican  Republic  to  the  Conference.  Those 
credentials  have  been  referred  to  the  respective  Committee.  Mean- 
while, following  the  rule  established  in  other  Conferences,  said  gen- 
tlemen are  temporarily  recognized  as  Delegates. 

Dr.  Ferrer.  Mr.  President,  I  would  request  you  to  propose  that 
the  name  of  Dr.  Guiteras,  the  distinguished  Delegate  from  the  United 
States,  be  added  to  the  Executive  Committee.  I  consider  his  presence 
in  that  body  as  necessary  in  a  large  measure.  He  is  fully  familiar 
with  the  subjects  before  this  Conference  and  in  direct  touch  with  the 
International  Bureau  of  Washington  with  which  will,  undoubtedly 
be  related  many  of  the  resolutions  to  be  passed  by  the  Conference. 

The  President.  I  am  really  suprised  to  hear  the  suggestion  of  the 
Delegate  from  Chile,  as  Dr.  Guiteras'  name  was  included  in  the  list 
that  was  prepared  to  propose  the  personnel  of  the  various  commit- 
tees. It  has  simply  been  an  omission  in  copying.  I  thank  Dr.  Ferrer 
for  the  opportunity  he  affords  me  for  amending  the  error.  If  there  is 
no  objection,  Dr.  Guiteras'  name  will  be  added  to  the  Executive  Com- 
mittee. 

(The  motion  was  unanimously  carried.) 

The  President.  To  continue  with  the  reading  of  the  reports,  I 
will  request  the  Delegate  from  Panama  to  take  the  floor. 

Dr.  Pardo  Correa.  Mr.  President,  I  am  sorry  to  find  myself  placed 
in  a  necessarily  difficult  position,  because  I  am  wholly  unable  to  fur- 
nish any  information  in  accordance  with  the  program  of  the  Con- 
ference. The  Republic  of  Panama  had  appointed  another  represen- 
tative who  was  unable  to  leave  in  due  time;  but  as  the  Government 
did  not  want  to  be  absent  from  this  Conference,  Panama  having  al- 
ways taken  an  active  participation  in  the  previous  meetings,  and  zeal- 
ously tried  to  comply  with  its  resolutions,  succeeding  in  placing  the 
country  upon  an  advantageous  sanitary  condition,  requested  me  by 
cable  to  assume  its  representation.  Also  by  cable,  I  have  received  the 
proper  authority  to  take  part  in  the  proceedings  and  votes.  I  repeat 
that  I  regret  my  inability  to  report  to  the  Conference  on  the  subjects 
under  consideration,  I  can,  however,  give  the  assurance  that  Panama 
shall  adhere  to  every  measure,  every  resolution  tending  to  benefit  the 
hygiene  and  health  of  the  countries  represented. 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  37 

Dr.  Urizar  and  Dr.  Oliver  then  read,  in  the  order  named,  their 
respective  reports  (see  pages  119  and  153). 

The  President.    The  Delegate  from  Venezuela  has  the  floor. 

Dr.  Razetti.  The  Venezuelan  Delegation,  in  compliance  with  a 
provision  of  the  program  submits  a  lengthy  report  and  also  a  resume 
or  extract  printed  in  English  and  Spanish.  Besides  in  accordance  with 
that  recommendation,  this  procedure  seems  highly  useful,  because  the 
mere  reading  of  the  report  is  not  sufficient  to  give  an  exact  idea  of 
the  informations,  plans  and  propositions  advanced.  Under  such  cir- 
cumstances, many  of  the  listeners  can  only  obtain  an  incomplete  and 
passing  impression,  whereas  a  publication  enables  all  to  act  with  pre- 
cision and  to  participate  in  the  discussions  and  to  vote  in  a  manner 
duly  deliberated.  (He  then  read  the  extract,  and  afterwards  dis- 
tributed copies  thereof  as  well  as  several  printed  volumes  containing 
comprehensive  information  on  the  different  subjects  dealt  within  the 
report.     (See  Appendix,  page  159.) 

The  President.     The  Delegate  from  Colombia  has  the  floor. 

Dr.  Vicencio.  I  have  not  as  yet  received  the  report  that  is  being 
prepared  in  my  country,  but  I  have  requested  that  it  be  sent  directly 
to  Washington,  and  I  hope  it  will  reach  in  time  to  be  inserted  in  the 
book  containing  the  transactions  of  the  Conference. 

The  President.    The  Delegate  from  Salvador  has  the  floor. 

Dr.  Miranda.  I  am  not  in  possession  of  complete  data  to  report 
upon  the  different  subjects  of  the  program.  He  then  read  several  pa- 
pers.    (See  Appendix,  page  111.) 

The  President.  Dr.  Vial,  a  member  of  the  Chilean  Delegation  has 
the  floor. 

Dr.  Vial.  The  report  of  the  Chilean  Delegation  is  not  strictly  in 
accordance  with  the  program  in  so  far  as  the  order  of  the  subjects  is 
concerned,  but  all  of  them  are  discussed  with  the  due  attention  and 
with  the  all  possible  care.  (He  then  read  the  printed  report,  copies 
of  which  were  distributed.    See  page  91.) 

Dr.  Cornejo  y  Gomez.  I  move  that  the  Conference  adopt  a  vote 
of  applause  to  the  distinguished  Chilean  Delegation  for  the  brilliant 
and  complete  report  which  it  has  submitted. 

Dr.  da  Rocha.  Warmly  applauding  the  motion  just  presented,  and 
as  a  compliment  thereto,  I  request  that  record  be  left  in  the  minutes 
of  the  good  impression  that  the  Brazilian  Delegation  has  experienced 
upon  visiting  the  Institute  of  Hygiene,  and  acquiring  a  close  knowl- 
edge of  Chile's  scientific  medical  service. 

(These  motions  were  carried  by  acclamation.) 

The  Secretary  read  the  report  of  the  Committee  on  Credentials. 
(See  page  72.) 

Dr.  Guiteras.  In  regard  to  that  report,  I  would  like  to  elucidate 
one  point.  I  would  move  that  it  be  distinctly  understood  that  Mr. 
Fortescue  is  not  a  Delegate  to  the  Conference.  He  has  been  granted 
the  privilege  of  the  floor,  but  not  as  a  Delegate.  I  understand  that 
Mr.  Fortescue's  admission  does  not  in  any  wise  alter  the  established 
rule. 

The  President.    A  mistake  has  evidently  been  made  in  the  report, 


38  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

which  will  be  rectified.  At  a  previous  session  I  invited  Captain  For- 
tescue  to  take  the  floor.  I  now  reiterate  the  invitation,  of  which  he 
may  avail  himself  at  such  moment  which  he  may  deem  opportune. 

I  think  it  is  now  in  order  to  have  the  committee  constituted  so  that 
they  may  start  their  work.  I  would  request  the  Delegates  to  present 
their  motions  so  that  these  may  be  referred  to  the  respective  Com- 
mittees to  be  reported  upon  and  submitted  to  the  Conference  for  dis- 
cussion. 

Dr.  Guiteras.  It  being  in  order,  as  I  understand  from  the  invi- 
tation of  the  President,  to  present  now  the  motions  or  proposed  reso- 
lutions, I  would  like  to  know  if  they  are  to  be  presented  to  the  Execu- 
tive Committee. 

The  President.  No,  sir.  The  motions  must  be  presented  to  the 
Conference  and  they  may  drafted  briefly.  Then  they  referred  to  the 
proper  Committees.    I  believe  this  is  the  most  practical  way. 

Dr.  Guiteras.  Then,  in  accordance  with  the  President's  statement, 
and  with  his  permission,  I  will  submit  a  motion. 

(Several  Delegates  read  the  motions  they  had  prepared.  See  Ap- 
pendix.) 

A  discussion  followed  as  to  the  presentation,  procedure  and  deliber- 
ation of  the  motions,  following  rules  being  adopted  by  unanimous 
vote : 

1st.  The  Delegations  shall  submit  their  motion  in  writing  to  the  Secretary 
before  the  next  session,  or  in  the  beginning  of  said  session.  They  may  draft 
the  motions  briefly,  reserving  the  right  to  submit  lengthier  drafts. 

2d.  The  motions,  according  to  this  nature,  shall  be  referred  to  the  proper 
Committees  which  shall  report  to  the  Conference,  recommending  the  adoption 
in  the  original  or  amended  form,  of  the  rejection  or  postponement  thereof. 
Motions  not  coming  under  the  jurisdiction  of  any  Committee  shall  be  referred 
to  the  Executive  Committee. 

3d.  For  the  discussion  of  the  reports  submitted  by  the  Committees,  the  Con- 
ference shall  follow  the  order  of  subjects  prescribed  by  the  program.  Within 
said,  the  motions  shall  be  discussed  in  alphabetical  order  of  countries  repre- 
sented. 

4th.  In  the  discussions,  the  limitation  of  time  shall  be  strictly  observed,  as 
established  by  the  regulations,  and  the  order  of  the  program  shall  be  followed. 

5th.  All  motions,  after  having  been  discussed,  shall  be  referred  to  the  Execu- 
tive Committee,  which,  after  revising  and  confronting  them,  shall  submit  the 
same  to  the  definite  vote  of  the  Conference.  The  Executive  Committee  may 
consolidate  two  or  more  similar  motions  into  one  single  resolution,  and 
propose  the  elimination  of  repeated  or  inconsistent  motions.  The  reports 
from  the  Executive  Committee  shall  not  be  subject  of  discussion.  The  votes 
shall  be  taken  by  aphabetical  order  of  nations. 

The  Secretary,  Dr.  Amunategui  transmitted  to  the  Conference  an 
invitation  extended  to  the  Delegates  by  Senor  Joaquin  Cabezas,  Di- 
rector of  the  Institute  of  Physical  and  Manual  Training,  to  visit  the 
establishment. 

(The  session  adjourned  at  4.30  P.  M.) 


FIFTH  DAY— THURSDAY,  NOVEMBER  9,  1911. 
Afternoon  Session. 

The  Conference  was  called  to  order  by  the  President,  Dr.  Alejandro 
del  Rio,  at  2  P.  M.,  nearly  all  the  Delegates  being  present.  By  re- 
quest of  the  President,  Dr.  Cornejo,  of  Ecuador,  and  Dr.  Guiteras,  of 
the  United  States,  sat  at  the  presidential  desk  in  their  capacity  as  Vice- 
Presidents  of  the  Conference. 

The  minutes  of  the  last  session  were  read  and  approved. 

The  President.  I  have  the  pleasure  to  grant  the  floor  to  the  Do- 
minican Delegation. 

Senor  Lizoni.  In  behail  of  the  Dominican  Republic,  I  have  the 
pleasure  to  wish  this  great  assembly  the  best  success  for  its  important 
labors.  At  the  same  time,  I  wish  to  assure  you  that  the  Government 
of  that  nation  will  make  it  its  duty  to  adopt  and  comply  with  the 
resolutions  that  may  be  passed.  I  regret  my  inability  to  report  upon 
the  subjects  prescribed  in  the  program,  as  I  have  received  neither  a 
report  nor  sufficient  data. 

The  President.  The  Chair  has  just  received  the  credentials  ac- 
credited Senor  Oscas  Valenzuela  Valdes  as  Delegate  from  Honduras. 
Said  credentials  have  been  referred  to  the  proper  committee.  Mean- 
while, following  the  established  procedure,  Sr.  Valenzuela  Valdes  is 
temporarily  recognized  in  his  capacity  as  Delegate.  As  he  is  not 
present  now,  I  shall  avail  myself  of  the  first  opportunity  to  offer  him 
the  floor  for  the  customary  salutation. 

Dr.  Ferre.  In  behalf  of  the  Chilean  Delegation,  I  submit  a  motion 
which  I  do  not  doubt  will  be  accepted  by  the  Conference  with  pleasure. 
The  day  before  yesterday,  there  was  inaugurated  in  Paris  by  the 
French  Minister  for  Foreign  Affairs,  the  Universal  Sanitary  Confer- 
ence. It  is  only  natural  that  this  American  Conference  should  send 
a  greeting  to  that  of  Paris,  in  view  of  our  affinity  of  object  and  pur- 
poses. I  move,  therefore,  that  the  President  be  authorized  to  transmit 
in  behalf  of  the  Conference  a  message  of  greeting  addressed  to  the 
Minister  for  Foreign  Affairs  of  France,  or  to  the  proper  officer. 

(The  motion  was  unanimously  carried.) 

Dr.  Guiteras.  I  wish  to  ask  the  Delegate  from  Chile  if  he  is  sure 
that  the  Paris  Conference  has  been  inaugurated.  I  was  under  the 
impression  that  that  Conference  had  been  postponed  a  second  time. 

Dr.  Ferrer.  It  was  inaugurated  yesterday  or  the  day  before  by 
one  of  the  members  of  the  French  cabinet. 

Dr.  Guiteras.  Very  well;  I  thank  the  Delegate  from  Chile  for 
his  information. 

The  reading  was  then  taken  up  of  the  different  motions  presented 
by  the  Delegations,  as  follows :  Argentine  Delegation,  3  motions ; 
Bolivian  Delegation,  2 ;  Brazilian  Delegation,  1 ;  Colombian  Delega- 
tion, 1  ;  Cuban  Delegation,  4 ;  Ecuadorian  Delegation,  1 ;  United  States 


40  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

Delegation,  3 ;  Paraguayan  Delegation,  1  motion  and  2  propositions ; 
Uruguayan  Delegation,  1 ;  Venezuelan  Delegation,  1.  The  Chilean 
Delegation  presented  several  motions,  as  follows :  5  signed  by  the 
President,  Dr.  del  Rio;  1,  by  Dr.  Ferrer;  1,  by  Dr.  Astaburuaga;  1,  by 
Dr.  Soza;  1,  by  Engineer  Illanes,  and  2,  by  Dr.  Amunategui. 

Some  of  the  Delegates  took  the  floor  for  the  purpose  of  formulating 
their  motions  or  explain  their  scope  and  significance. 

(The  motions  were  referred  to  the  respective  committees,  and  they 
appear  in  the  Appendix.) 

Dr.  Araoz  Alfaro,  in  behalf  of  the  Argentine  Delegation,  pre- 
sented an  extract  of  reports  previously  submitted  to  the  Conference 
by  said  Delegation. 

The  President.  In  accordance  with  the  regulations,  it  is  now 
in  order  to  undertake  the  discussion  of  the  different  subjects  of  the 
program,  in  their  numerical  order. 

(A  short  while  after  the  consideration  of  the  subjects  was  begun, 
the  Conference  decided  to  abandon  this  procedure  because  it  was 
deemed  of  little  advantage  and  that  it  was  more  useful  to  proceed 
with  the  discussion  when  the  motions  were  considered.) 

Upon  suggestion  of  Dr.  Fernandez  Espiro,  it  was  decided  that  two 
sessions  should  be  held  on  the  following  day  (Friday),  one  at  9:30 
A.  M.  and  another  at  the  usual  time,  2  P.  M. 

(The  session  adjourned.) 


SIXTH   DAY— FRIDAY,   NOVEMBER    10,    1911. 
Morning  Session. 

The  Conference  was  called  to  order  at  10  A.  M.  by  the  President, 
Dr.  del  Rio,  nearly  all  the  Delegates  being-  present.  By  request  of  the 
President,  Dr.  Ortega,  of  Guatemala,  and  Dr.  Monjaras,  of  Mexico, 
sat  at  the  presidential  desk  in  their  capacity  of  Vice-Presidents  of 
the  Conference. 

The  minutes  of  the  previous  session  were  read  and  approved. 

More  motions  were  submitted  by  Dr.  Monjaras,  Dr.  Roberts  and 
Dr.  Manterola.  They  were  referred  to  the  respective  committees. 
(See  the  Appendix.) 

Several  committees  reported  upon  the  motions  referred  to  them, 
and  the  discussion  of  their  reports  was  taken  up  in  the  order  and 
manner  below  stated. 

The  Committee  on  Chronic  Contagious  Diseases  reported  favorably 
upon  Dr.  Urizar's  motion  on  leprosy. 

Dr.  Corbalan  Melgarejo.  I  believe  to  have  understood  that  it 
is  recommended  that  the  Governments  adopt  measures  for  the  eradi- 
cation of  leprosy.  If  such  is  the  meaning  of  the  proposed  resolution, 
I  would  like  to  state  my  doubts  as  to  whether  this  subject  would 
come  under  the  jurisdiction  of  the  Conference,  because  it  is  not  a 
matter  of  international  sanitary  police  requiring  the  imposition  of 
quarantine  or  preventive  measures.  A  patient  arriving  at  a  port,  dis- 
embarks or  remains  on  board  but  the  vessel  is  always  received.  The 
matter  is  a  subject  for  regulation  only  in  so  far  as  the  policing  of 
immigration  is  concerned.  Every  country  may  defend  itself  against 
leprosy  or  other  contagious  diseases  in  general,  but  with  measures  of 
purely  local  nature.  In  Chile  the  passage  of  a  law  is  contemplated 
prohibiting  the  introduction  of  foreigners  sufferings  from  chronic 
contagious  diseases,  and  ordering  that  they  be  returned  to  the  country 
of  origin. 

Dr.  Urizar.  I  wish  to  explain  the  meaning  and  scope  of  my 
proposition  in  view  of  the  remarks  by  the  distinguished  Delegate  from 
Chile.  The  motion  does  not  imply  an  international  sanitary  provision. 
Its  purpose  is  not  to  induce  Governments  to  enact  laws  of  that  kind. 
It  is  simply  to  advise  the  Governments  of  countries  where  leprosy 
prevails  to  compile  statistics  for  the  purpose — quite  natural  and  nec- 
essary— of  ascertaining  the  number  of  lepers,  the  places  where  they 
live,  etc.,  which  data  will  help  in  devising  the  means  conducive  to 
the  eradication  of  the  disease  and  facilitating  the  study  of  its  etiology. 
Undoubtedly,  the  prophylaxis  of  this  disease  has  been  and  shall  be  a 
matter  of  wide  discussion,  for  the  very  reason  that  affecting  chronic 
patients  it  is  difficult  to  prescribe  that  they  be  deprived  of  their  liberty, 
systematically.  But  the  proportions  that  leprosy  is  assuming,  justify 
and  render  indispensable  the  recommendations  that  I  propose,  which 


42  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

refer  to  the  internal  legislation  of  each  country,  which  could  adopt 
them,  employing  its  means,  according  to  its  customs  and  capacity. 

Dr.  Guiteras.  The  measures  recommended  by  the  proposition  in 
question,  are  undoubtedly  plausible  enough,  but  I  understand  that  all 
countries  have  already  adopted  such  measures.  In  the  report  of  the 
American  Delegation,  there  is  stated  what  the  United  States  have 
done  in  this  particular.  In  my  opinion,  all  the  countries  of  the  Amer- 
ican continent  have  advanced  enough  to  see  the  advisability  of  enforc- 
ing measures  of  this  kind. 

Dr.  Alvarez.  Leprosy  prevails  in  the  Argentine  Republic  and  I 
accept  the  motion  in  view  of  the  necessities  of  my  country.  We  have 
not  complete  leprosy  statistics  and  have  not  yet  enforced  isolation 
measures.  It  was  only  recently  that  it  was  decided  to  establish  a 
leper  asylum  in  Entre  Rios  for  the  purpose  of  isolating  there  those 
that  have  been  at  liberty. 

Dr.  Roberts.  I  will  inform  in  regard  to  what  is  done  in  my  coun- 
try. Leprosy  prevails  in  Cuba  and  we  have  leper  asylums.  Every 
leper  must  be  isolated  in  those  establishments,  unless  it  is  proven  that 
he  has  the  means  to  be  isolated  and  attended  in  his  own  home  in 
such  a  way  that  it  will  not  constitute  a  menace  to  society.  A  leper 
having  the  means  to  do  so,  does  not  isolate  himself  properly,  is  forci- 
bly confined. 

Dr.  Araoz  Alfaro.  I  am  going  to  supplement  the  information 
furnished  by  my  distinguished  co-Delegate,  Dr.  Alvarez,  by  adding 
some  data.  Although  these  statistics  are  very  incomplete,  it  may  be 
established  with  certainty  that  there  are  more  than  three  hundred  cases 
in  the  Argentine  territory,  located  specially  in  certain  districts  of 
Corrientes  and  Entre  Rios.  A  year  ago  there  was  held  in  Buenos 
Aires  a  National  Congress  on  Leprosy,  and  among  the  measures  pro- 
posed by  the  Congress  there  is  the  establishment  of  a  leper  colony 
in  an  island  of  the  first-named  province.  In  my  opinion,  the  motion 
in  question  might  be  amended,  but  I  agree  with  the  idea,  and  I 
abstain  from  suggesting  any  amendments. 

Dr.  da  Rocha.  I  agree  with  the  proposition  of  the  Delegate  from 
Paraguay,  and  I  accept  it.  In  Brazil  we  have  in  force  measure*,  to 
that  end,  which  in  some  States,  as  Sao  Paulo  and  Rio  de  Janeiro,  at  J 
very  stringent. 

Dr.  Corbalan.  In  view  of  the  explanations  given  by  the  Delegate 
from  Paraguay,  and  understanding  now  perfectly  the  meaning  of  his 
motion,  I  shall  give  it  my  vote. 

Dr.  Monjaras.  The  motion  now  being  discussed,  comprises  sev- 
eral points  of  importance.  The  first  refers  to  what  the  national  gov- 
ernments may  do,  and  to  this  end  the  Fourth  Conference  adopted  a 
resolution  which  confines  itself  to  recommending  the  different  govern- 
ments that  they  "adopt  such  measures  as  they  may  deem  advisable." 
To  take  into  consideration  a  standpoint  of  greater  importance,  I  will 
say  that  the  defense  against  leprosy  has  two  aspects,  to  wit:  the 
defense  within  the  country  and  the  defense  to  prevent  leprosy  from 
being  introduced  from  any  nation.  In  Mexico,  Cuba  and  the  United 
States  lepers  are  not  admitted  upon  arrival  at  a  port  or  at  the  frontier, 
and  likewise  they  are  not  permitted  to  leave  the  country.     In  this  way 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  43 

the  international  side  of  the  question  is  disposed  of.  With  respect  to 
the  interior  of  each  country,  it  is  obvious  that  all  governments  can 
adopt  such  measures  as  they  may  see  fit.  My  opinion  would  be  that 
we  merely  refer  to  what  was  resolved  by  the  Fourth  Conference. 

Dr.  Urizar.  My  motion  refers  in  the  first  place  to  the  compilation 
of  complete  statistics  by  each  country,  not  only  as  a  national  measure, 
but  also  for  the  purpose  of  ascertaining  the  extent  of  the  propagation, 
which  is  very  important  from  the  scientific  standpoint.  Therefore, 
my  proposition  concretes  and  defines  in  a  better  way  the  recommen- 
dation made  by  the  Fourth  Conference  to  the  governments,  and  to 
this  end  a  mere  reference  to  that  recommendation  would  not  be 
sufficient. 

(There  being  no  more  Delegates  desiring  to  speak  on  the  subject,  the 
discussion  was  ended  at  this  piint.  In  accordance  with  the  rules,  the 
motion  was  referred  to  the  Executive  Committee.) 

The  President's  motion  on  scleroma  was  favorably  reported  upon 
by  the  respective  committee,  and  there  being  no  discussion  thereon, 
it  was  referred  to  the  Executive  Committee.    (See  Appendix.) 

Dr.  Araoz  Alfaro.     This  disease  is  unknown  in  many  countries. 

Dr.  Roberts.     It  exists  in  Cuba,  but  the  cases  are  few. 

Dr.  Ortega.  It  is  very  frequent  in  Guatemala,  in  comparison  to 
other  acute  diseases ;  the  same  is  true  of  Salvador. 

The  President's  motion  on  the  regulation  of  prostitution  was  favor- 
ably reported  upon  by  the  Committee  on  Prophylaxis.  (See  Appen- 
dix.) 

Sr.  Alfonso.  It  has  been  generally  believed  that  the  regulation 
of  prostitution  is  a  scientific  means  of  limiting  the  ravages  of  venerea] 
diseases.  But,  as  the  Delegates  know,  eminent  authorities  on  syphil- 
ology  have  reached  the  conclusion  that  it  is  not  worth  while  to  adopt 
such  a  regulation.  I  submit  this  idea  to  the  consideration  of  the  Con- 
ference; in  fact,  this  thesis,  which  offhand  seems  rather  extravagant, 
is  worthy  of  being  taken  into  consideration  after  one  has  studied  the 
reasons  upon  which  its  authors  base  their  opinion. 

Dr.  Monjaras.  In  Mexico,  the  regulation  of  prostitution  has  been 
in  force  for  many  years.  There  has  been  taken  a  statistical  table  of 
the  propagation  of  venereal  diseases  by  registered  persons,  that  is  to 
say  by  those  whose  names  are  recorded  in  the  books  kept  for  that  pur- 
pose— and  by  persons  who  in  Mexico  are  called  ambulantes  (ped- 
dlers), and  that  operate  clandestinely.  This  table  has  shown  in  an 
evident  manner  that  the  greater  the  clandestinity  the  larger  the  number 
of  cases.  Well-to-do  patients  are  asked  how  they  contracted  the  dis- 
ease, and  through  their  answers  the  woman  is  looked  for,  and  most 
times  we  find  that  she  also  is  suffering  from  the  same  malady.  In 
other  instances  we  find  that  the  disease  has  been  acquired  in  a  house, 
and  upon  investigation  it  turns  out  that  it  was  communicated  by  a 
clandestine  woman.  As  a  rule  the  physicians  have  observed  that  the 
regulation  of  prostitution  is  beneficial. 

Dr.  Bianchi.  I  do  not  think  that  it  is  not  pertinent  for  me  to 
argue  in  favor  or  against  regulation.  I  only  want  to  say  that  the 
regulation  of  prostitution  in  women  is  not  sufficient.     It  would  be 


44  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

necessary  to  include  men  in  the  procedure  suggested  by  Dr.  Mon- 
jaras, because  a  man  can  at  intervals  transmit  the  infection.  I  think 
that  long  as  our  customs  do  not  permit  the  enforcement  of  a  really 
scientific  regulation,  it  is  better  to  confine  the  campaign  to  the  popu- 
larization of  the  methods  of  individual  prophylaxis.  At  any  rate, 
this  Conference,  which  is  in  a  way  something  like  the  Supreme  Court 
of  Hygiene  in  America,  should  not  declare  itself  openly  for  or  against 
regulation  until  the  great  hygienists  of  the  world  shall  have  reached 
an  agreement  on  the  subject. 

Dr.  Sanjines.  In  Bolivia,  prostitution  has  recently  been  regulated 
in  some  cities.  In  my  opinion,  the  immediate  isolation  of  the  patient 
should  be  required,  and  no  patient  should  be  allowed  to  trade  until 
she  has  been  cured.  I  would  add  that  strict  persecution  of  clandestine 
prostitution  be  recommended. 

Dr.  Araoz  Alfaro.  I  believe  that,  as  a  whole,  the  proposition  is 
well  termed.  In  the  Argentine  Republic  the  regulation  has  been  in 
force  for  a  long  time,  and  it  may  be  said  that  it  is  so  now  even  in  the 
smallest  cities.  In  accordance  with  the  opinion  of  Drs.  Monjaras  and 
Sanjines,  that  regulated  prostitution  is  less  dangerous.  As  the  manner 
of  the  regulation,  the  Conference,  in  my  opinion,  should  not  pronounce 
itself.  In  Chile  they  speak  of  isolation ;  in  the  Argentine  Republic 
we  have  tried  both  systems,  that  is  to  say,  isolating  the  patients  or 
letting  them  free,  not  to  trade  but  to  cure  themselves  in  their  own 
homes.  In  accordance  with  the  statement  of  the  Delegate  from  Guate- 
mala, it  would  be  advisable,  both  from  the  moral  and  scientific  stand- 
point, that  the  investigation  be  made  applicable  to  men  also ;  but,  of 
course,  this  is  quite  difficult  from  the  practical  standpoint. 

Dr.  da  Rocha.  In  Brazil  this  is  a  question  under  consideration, 
because  we  want  to  make  the  defense  against  the  disease  consistent 
with  individual  liberty.  Personal  defense  would  perhaps  be  more 
effective  than  a  strict  regulation. 

Dr.  Roberts.  As  stated  in  the  report  of  the  Delegation,  regulation 
is  enforced  in  Cuba.  Statistics  show  that  venereal  diseases  are  more 
frequent  where  clandestine  prostitution  prevails.  Oftentimes  it  hap- 
pens that  when  a  registered  prostitute  feels  sick  she  undertakes  to 
operate  clandestinely.  The  inspection  of  houses  of  prostitution  is 
made  twice  a  week.  A  night  dispensary  has  been  established  for  the 
treatment  of  men,  as  stated  in  the  report.  This  dispensary  is  resorted 
to  by  men  who,  on  account  of  their  financial  situation,  can  not  bear 
the  expenses  of  medical  attendance,  or  who  by  reason  of  their  occupa- 
tion can  not  be  treated  in  day  time. 

Dr.  Manterola.  I  support  the  proposition  of  the  Chilean  Delega- 
tion. Through  investigations  made  by  Dr.  Astaburuaga  and  myself, 
it  has  been  ascertained  that  in  this  country,  also,  particularly  in  Val- 
paraiso, what  Dr.  Monjaras  has  said  is  true,  that  is  to  say,  that 
clandestine  prostitution  causes  more  damages  than  public  or  regulated 
prostitution.  I  believe,  as  the  Guatemalan  Delegate  does,  that  regula- 
tion should  be  extended  also  to  men  who  communicate  the  infection. 
At  any  rate,  it  seems  to  me  that  women  should  have  the  right  to 
demand  the  examination  of  the  man  who  communicated  the  disease. 
The  mere  fact  that  the  man  pays  does  not  give  him  the  right  to 
cause  such  a  damage. 


FIFTH    INTERNATIONAL   SANITARY   CONFERENCE.  45 

Dr.  Corbalan.  I  accept  the  motion  proposed  by  the  President. 
Many  times  I  have  examined  in  my  office  men  who  contracted  the 
disease  from  women  who  traded  with  a  clean  bill  of  health.  It  is 
therefore  necessary  that  there  be  a  competent,  careful  and  honest 
corps  of  inspectors. 

The  President.  I  am  going  to  say  four  words  in  order  to  explain 
the  motive  of  my  proposition.  I  am  well  aware  that  in  every  country 
there  are  men  who  favor  and  others  who  oppose  the  idea  of  regula- 
tion of  prostitution.  But  the  truth  is  that  in  order  that  regulation, 
in  countries  adopting  it,  may  be  efficient,  it  is  necessary  that  it  be 
enforced  under  certain  requirements,  and  the  necessity  of  such  require- 
ments should  be  emphasized,  because  if  they  are  not  complied  with, 
the  regulation  is  then  deceiving  and  dangerous.  It  is,  of  course,  nec- 
essary that  the  inspection  should  be  made  by  competent  physicians. 
This  suggestion  may  seem  paradoxical,  but  the  truth  that  such  a 
service  should  be  in  charge  of  specialists.  In  many  cities  in  Chile 
the  examination  of  prostitutes  is  made  at  their  own  houses.  Such  a 
commission  is  not  in  keeping  with  a  physician's  dignity,  aside  from 
the  fact  that  he  can  not  be  provided  with  the  proper  means  for  such 
an  examination.  We  all  know  that  the  diagnosis  of  syphilis  is  some- 
times difficult. 

For  these  reasons  I  have  moved  that  it  be  recommended  that  the 
inspection  be  made  by  specially  prepared  physicians,  and  in  dispen- 
saries or  polyclinics.  As  in  many  cases  it  is  necessary  to  make  a 
microscopical  examination  of  the  spirochaete  and  the  gonococcus, 
there  should  be  a  laboratory  annex  where  it  could  be  made  properly. 

Dr.  Astaburuaga.  In  the  regulations  governing  prostitution  an 
age  limit  is  generally  prescribed  for  women  engaging  in  the  trade, 
which  age  is  about  eighteen  years.  But  Dr.  Manterola  and  I  have 
observed  in  Valparaiso  that  a  great  number  of  prostitutes  there  have 
not  attained  that  age,  specially  those  who  peddle  in  the  streets  looking 
for  clients.  I  consider  that  this  point  should  be  taken  into  considera- 
tion and  a  solution  given  thereto. 

The  President.  The  Executive  Committee  will  take  up  this  sub- 
ject and  submit  to  the  Conference  in  definite  form. 

(The  motion  under  discussion  was  referred  to  the  Executive  Com- 
mittee.) 

Dr.  Soza's  motion  on  tuberculosis,  having  been  favorably  reported 
upon  by  the  respective  committee,  was  then  taken  for  discussion. 
(See  Appendix.) 

Dr.  Araoz  Alfaro.  In  nearly  all  the  countries  there  are  anti- 
tuberculosis leagues.  In  the  Argentine  Republic  there  is  a  very  im- 
portant, whose  Director  is  Dr.  Emilio  Coni.  Accepting  the  motion, 
I  would  like  to  know  if  what  is  proposed  is  the  appointment  of  an  of- 
ficial commission. 

Dr.  Soza.  I  have  explained  all  my  ideas  on  the  subject  in  a  pamphlet 
that  has  been  distributed  among  the  Delegates.  In  many  countries, 
in  France,  for  instance,  there  is  a  considerable  number  of  associations 
against  tuberculosis,  but  as  they  operate  without  any  concerted  action, 
they  do  not  accomplish  the  results  desired.  They  act  as  soldiers  with- 
out a  chief.     An  eminent  French  author  has  said  that  the  money  is 


46  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

being  thrown  away  without  any  profit  whatever.  The  purpose  of  the 
motion  is,  therefore,  to  make  uniform  the  action  of  these  associations 
by  combining  the  efforts.  On  the  other  hand,  the  Governments  would 
be  free  to  act  according  to  circumstances  and  in  accordance  with  the 
means  of  action  at  their  disposal. 

Dr.  da  Rocha.  In  Brazil,  as  in  many  other  places,  there  are 
leagues  of  that  kind,  but  without  a  special  jurisdiction  over  them. 
This  is  a  municipal  matter  in  that  Republic,  but  the  Federal  Govern- 
ment renders  financial  help  which  sometimes  exceeds  170,000  pesos. 
A  federal  tax  has  been  levied  on  banks,  the  products  of  which  are  de- 
voted to  that  purpose. 

Dr.  Fernandez  Espiro.  I  second  Dr.  Soza's  motion,  because  in  my 
opinion  it  tends  to  overcome  difficulties  in  some  countries  where  there 
are  various  organizations  with  the  same  purpose  but  independent  from 
each  other.  (He  then  stated  what  is  done  in  Uruguay  in  this  par- 
ticular.) 

Dr.  Manterola.  I  also  support  the  motion. 

(The  motion  was  referred  to  the  Executive  Committee.) 

The  motion  presented  by  Dr.  Razetti  on  malaria  having  been  favor- 
ably reported  upon  by  the  Committee  on  Malaria  and  Yellow  Fever, 
was  then  brought  up  for  discussion  (see  Appendix). 

Dr.  Razetti.  In  an  annex  to  the  report  of  the  Venezuelan  Delega- 
tion, the  Delegates  will  find  the  conclusions  reached  by  the  Simla  Con- 
ference, in  which  a  very  complete  and  interesting  study  was  made  of 
the  means  for  the  eradication  of  malaria,  such  as  the  destruction  of 
mosquitoes  by  draining  lands,  pouring  kerosene  oil,  etc.  The  conclu- 
sions of  that  Conference,  which  was  attended  by  the  most  eminent 
physiciansof  England,  will  be  of  great  service  in  intertropical  countries 
for  a  systematic  campaign  against  malaria. 

Dr.  Araoz  Alfaro.  Malaria  is  so  widely  distributed  throughout  the 
American  Continent,  that  everything  that  refers  to  its  eradication  has 
in  my  opinion  a  great  collective  interest.  Therefore,  I  second  with 
enthusiasm  the  proposition  of  the  Venezuelan  Delegation;  but  as  I  do 
not  know  in  detail  the  conclusions  of  the  Simla  Conference,  I  shall  con- 
fine myself  to  outlining  briefly  what  is  done  in  my  country.  In  the 
Argentine  Republic  we  have  an  area  of  nearly  400,000  square  kilo- 
meters— out  of  a  total  of  3,000,000 — affected  by  malaria,  generally  of  a 
mild  nature,  few  acute  cases  occurring  and  without  cachexia.  The  law 
that  is  now  being  enforced  provides  for  all  forms  of  prophylaxis  en- 
forced in  the  most  advanced  countries,  especially  Italy,  where,  as  we 
all  know,  there  are  experts  who  advocate  quinization  only,  and  others 
who  favor  the  fight  against  mosquitoes.  In  my  country  the  methods 
in  use  are :  Preventive  quinization  and  curative  treatment  of  patients ; 
fight  against  mosquitoes  (mechanical  protection  of  patients;  drainage 
of  swamps  ;  elimination  of  stagnated  waters  ;  petrolization  and  mechan- 
ical protection  of  waters ;  fumigation  and  destruction  of  mosquitoes, 
etc.)  Besides,  it  is  proposed  to  make  anti-malarial  education  in  the 
schools  as  wide  as  possible.  I  would  like  to  know  if  the  proposition 
of  the  Venezuelan  Delegation  includes  something  more. 

Dr.  Razetti.  The  measures  outlined  by  the  Argentine  Delegate  are 
the  basis,  which,  among  others,  may  be  adopted  for  the  eradication  of 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  47 

malaria.  The  meaning-  of  the  motion  is  confined  to  the  fight  against 
mosquitoes — because  it  is  not  sufficiently  practical  to  accomplish  the  de- 
sired result.  It  is  necessary  to  combine  all  means,  and  this  is  what  the 
Simla  Conference  did,  which  Conference  has  sanctioned  the  fight 
against  mosquitoes,  education  of  the  people,  quinization,  etc.  We,  in- 
stead of  devising  the  plan  of  campaign,  should  adopt  what  is  already 
done,  recommending  it  to  the  interested  Governments.  This  is  the 
object  of  the  motion  now  under  discussion. 

Dr.  Perry.  Measures  that  may  be  applicable  to  a  certain  locality 
might  be  impracticable  in  other  places.  Therefore,  the  adoption  of 
different  methods  would  be  advisable.  The  measures  adopted  in 
Panama,  in  the  Canal  Zone,  are  the  same  as  those  in  common  use  in 
other  countries.  The  procedure  consists  of  attacking  the  chain  at  its 
two  ends,  man  and  mosquito.  A  way  of  destroying  mosquitoes,  ex- 
plained in  detail  in  a  publication  that  I  have  issued,  is  to  catch  the 
insect  in  traps  adequately  arranged.  This  means  facilitates  the  calcu- 
lation of  the  amount  of  mosquitoes  in  a  certain  locality,  which  is  a  very 
important  data  in  determining  the  seriousness  of  the  danger  caused 
by  malaria  at  that  point. 

Dr.  Sanjines.  The  measures  recommended  in  the  motion  will  be 
of  great  interest  in  Bolivia,  and,  therefore,  I  accept  it  with  much  en- 
thusiasm. 

Dr.  Guiteras.  An  important  means  of  ascertaining  the  existence 
and  extent  of  malaria  would  be  to  provide  that  all  cases  that  may  occur 
should  be  reported  to  the  sanitary  authorities.  In  report  of  the  United 
States  Delegation  mentio  nis  made  of  the  States  of  the  Union — still 
very  few — yhere  it  is  compulsory  to  report  all  cases  of  malaria,  typhus 
and  other  communicable  diseases. 

Dr.  Ferrari.  In  measures  employed  in  Brazil  to  fight  malaria,  the 
principal  object  is  the  destruction  of  mosquitoes,  but  it  is  not  indeed 
the  means  resorted  to.  For  instance,  four  years  ago  the  Municipality 
of  Rio  Janeiro  enacted  measures  of  protection  for  laborers  employed 
in  the  canalization  of  waters,  in  order  to  prevent  the  apparition  or  in- 
crease of  the  disease.  The  works  of  the  Maderia  Mamore  Railroad 
had  to  be  abandoned  because  malaria  used  to  decimate  the  laborers 
employed  in  the  construction.  At  present  the  work  has  been  renewed 
by  an  American  Company,  which  applies  preventive  and  curative 
measures ;  not  only  the  destruction  of  mosquitoes,  but  also  quinization 
and  other  means  which  have  been  recommended  as  more  efficient  and 
practicable. 

(It  being  considered  that  the  motion  had  been  sufficiently  debated, 
it  was  referred  to  the  Executive  Committee.) 

The  President  conveyed  to  the  Delegates  an  invitation  from  the 
Mayor  of  Valparaiso,  to  visit  the  water  works  of  Pefiuelas.  (The  in- 
vitation was  accepted  by  the  majority.) 

The  session  adjourned  at  12  m. 


Afternoon  Session. 

The  Conference  was  called  at  3  :30  p.  m.  to  order  by  the  President, 
Dr.  Alejandro  del  Rio,  nearly  all  the  Delegates  being  present.     The 


48  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

President  requested  Dr.  Pardo  Correa,  Delegate  from  Panama,  and 
Dr.  Urizar,  from  Paraguay,  to  seat  with  him  at  the  presidential  desk, 
in  their  capacity  as  Vice-Presidents  of  the  Conference.  The  minutes 
of  the  previous  session  were  not  read,  as  they  were  not  yet  ready,  but 
the  Chair  was  authorized  to  approve  them. 

On  motion  of  Dr.  Guiteras  it  was  resolved  that  in  discussing  the 
different  motions  only  their  authors  and  the  Delegates  wishing  to  ob- 
ject to  them  be  allowed  to  speak  thereon. 

Several  new  motions  just  delivered  at  the  Secretary's  office  were 
read  and  referred  to  the  respective  committees. 

The  Committee  of  Yellow  Fever  submitted  its  report  on  the  motions 
of  Dr.  Guiteras  and  Dr.  Roberts,  on  yellow  fever,  without  recommen- 
dation.    (See  Appendix.) 

Dr.  Guiteras.  At  the  present  time,  the  opinion  on  the  transmission 
of  yellow  fever  is  very  different  from  that  of  years  ago.  Formerly,  it 
was  considered  that  when  a  person  had  suffered  an  attack,  a  repetition 
would  very  seldom  take  place.  Now  it  is  said  that  a  person  may  live 
ten  years  in  an  endemic  place,  go  to  immune  countries  ,and  contract  the 
disease  a  second  time  upon  returning  to. the  endemic  place.  An  emi- 
nent English  authority  has  made  very  interesting  studies  on  the  sub- 
ject, and  his  investigations  show  that  the  mere  fact  of  having  resided 
for  ten  years  in  an  endemic  locality  can  not  be  taken  as  constituting 
sufficient  immunity. 

Another  point:  A  place  is  considered  as  endemic  even  if  very  few 
cases  of  the  disease  appear  therein.  Supposing  that  there  occur  in  a 
port  only  ten,  or  five,  cases  during  one  summer,  in  the  tropics  that 
place  would  be  considered  as  an  endemic  locality.  It  is  possible  to 
consider  that  one  can  live  for  a  long  time  in  an  endemic  place  without 
coming  in  contact  with  the  mosquito ;  and  it  is  also  possible  one  can, 
without  taking  any  precaution,  spend  many  years  without  contracting 
the  disease.  Possessing  the  present  knowledge  on  yellow  fever,  I 
consider  that  a  sensible  person  and  therefore  exercising  some  case  in 
order  to  guard  himself  can  live  quite  confidently  in  an  infected  locality 
without  fearing  the  disease.  By  taking  precautions  one  can  avoid  the 
bite  from  a  mosquito.  Nowadays,  exactly  the  same  is  true  of  yellow 
fever  as  it  is  of  cholera.  One  can  live  in  a  place  infected  with  cholera 
without  contracting  the  disease ;  all  that  is  necessary  to  boil — or  to 
reach  only  a  certain  degree  to  kill  the  Koch  baccilu — eatables  and  bev- 
erages. I  am  really  of  the  opinion  that  there  should  be  no  immunity 
declared  against  yellow  fever;  but  since  the  subject  is  mentioned  in 
the  Washington  Convention,  we  should  take  it  into  consideration.  Of 
course,  we  should  take  the  most  advanced  point  possible,  as  would 
be  case  of  fever  reported  by  a  competent  physician  who  knows  the 
disease. 

Dr.  Roberts.  The  subject  under  discussion  is  quite  simple,  and  un- 
doubtedly all  the  Delegates  have  already  formed  an  opinion.  The  ques- 
tion at  issue  is  merely  to  decide,  for  practical  quarantine  purposes,  of 
protracted  residence  in  an  endemic  focus  can  be  taken  as  constituting 
indemnity,  even  if  the  individual  has  not  suffered  from  the  disease,  as 
is  now  the  rule  in  Cuba,  United  States  and  Mexico.  We  must  bear  in 
mind  that  the  motion  deals  with  the  subject  of  the  program,  referring 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  49 

to  immunity  from  yellow  fever  from  the  standpoint  of  quarantine.  It 
is  true  that  from  a  theoretical  standpoint,  immunity  is  something  that 
can  not  be  conclusively  assured.  But  in  Cuba,  where  yellow  fever  has 
been  endemic  for  a  long  time,  the  statistics  show  that  after  six  years 
it  is  very  seldom  that  one  contracts  the  disease.  Every  foreigner, 
when  contracting  the  disease,  acquires  it  before  completing  six  years 
of  residence.  And  the  same  is  true  of  natives  contracting  the  borras 
fever,  which  is  etiologically  considered  as  yellow  fever.  There  is  no 
doubt,  of  course,  that  sometimes  one  may  live  in  an  endemic  focus  and 
yet  not  acquire  immunity;  but  the  number  of  cases  in  which  such  a 
thing  might  happen  is  so  insignificant,  that  I  do  not  believe  there  is 
any  danger  worthy  of  being  taken  into  consideration ;  on  this  ground, 
I  ratify  my  motion  in  the  sense  that,  for  the  practical  purposes  of 
quarantine  against  yellow  fever,  a  residence  of  ten  continuous  years 
in  an  endemic  focus  can  be  accepted  as  constituting  immunity. 

Dr.  Monjaras.    What  is  the  point  under  discussion? 

The  Secretary,  Dr.  Amunategui.  It  should  be  the  report  of  the 
committee ;  but  it  happens  that  the  committee  has  merely  referred  the 
two  motions  to  the  Conference,  without  making  any  recommendations. 

Dr.  Roberts.  The  case  is  very  easily  explained.  There  were  two 
motions  each  favoring  a  different  opinion,  and  as  they  had  been  sub- 
mitted by  two  Delegates  forming  part  of  the  committee,  this  body 
deemed  it  proper  to  abstain  from  making  any  recommendations. 

Dr.  Monjaras.  There  being  no  recommendation,  we  must  discuss 
the  proposition  on  the  floor  of  the  Conference.  It  is  of  vital  impor- 
tance to  determine  the  question  in  one  way  or  other,  and  this  should 
be  made  from  a  practical  standpoint,  and  avoiding  the  obstacles  of  an 
extreme  attitude.  Dr.  Guiteras  proposes  that  a  certificate  from  a  com- 
petent physician  should  be  required ;  but  such  a  procedure  would  pre- 
sent a  serious  obstacle,  because  we  must  first  know  who  is  com- 
petent. 

Dr.  Guiteras.  I  referred  to  the  authorities,  whose  duty  it  is  to 
watch  over  matters  pertaining  to  public  health. 

Dr.  Monjaras.  It  is  assumed  that  public  health  officers  are  com- 
petent, even  though  in  fact  they  may  not  be  so.  Perhaps  a  medical 
certificate,  duly  authenticated,  is  sufficient,  even  if  the  physician  issuing 
it  is  not  a  public  health  officer. 

Dr.  Razetti.  The  idea  that  has  just  been  stated  there  is  a  serious 
practical  inconvenience.  The  physicians  do  not  certify  as  a  rule.  Then 
again,  the  physician  who  attended  a  patient  may  have  died,  or  absented 
himself  at  the  time  when  a  person  wants  to  obtain  a  certificate  from 
him.  Or  the  patient  himself  may  have  changed  his  residence  and  is 
thus  unable  to  secure  a  certificate  from  his  physician.  The  health 
authorities  of  Porto  Rico  require  the  certificate.  Thus,  a  person  de- 
siring to  go  there  applies  to  any  physician  for  a  certificate  stating  that 
lie  has  suffered  from  yellow  fever.  As  a  matter  of  fact,  such  docu- 
ments, thus  secured,  are  worth  nothing.  I  believe  that  the  fact  of 
having  resided  a  long  time  in  an  endemic  place  is  more  worthy  of  con- 
sideration. 

Dr.  Alvarez.  But,  such  a  man,  such  a  passenger,  does  he  constitute 
a  danger  to  the  home  where  he  intends  to  go  to? 


50  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

Dr.  Razetti.  I  believe  he  does  not.  If  he  is  taken  sick  with  fever, 
the  sanitary  authorities  will  isolate  him.  I  do  not  believe  that  an  in- 
dividual should  be  refused  admission  into  a  country  just  because  he 
has  not  suffered  from  yellow  fever.  An  individual  who  has  contracted 
syphilis  is  more  dangerous.  In  a  word,  I  do  not  attach  any  practical 
importance  to  a  certificate. 

(The  subject  being  considered  sufficiently  discussed,  the  motions 
were  referred  to  the  Executive  Committee.) 

A  report  from  the  Committee  on  Prophylaxis  of  Acute  Diseases,  was 
then  read,  it  being  upon  a  motion  by  the  Argentine  Delegation  pro- 
posing that  the  Governments  be  recommended  to  have  school  teach- 
ers learn  how  to  vaccinate.  The  report  recommended  that  the  motion 
be  rejected. 

(There  being  no  discussion  it  was  referred  to  the  Executive  Com- 
mittee.) 

Another  report  from  the  same  committee  was  read,  recommending 
the  approval  of  a  motion  by  Dr.  Sanjines.     (See  Appendix.) 

Dr.  Vicencio.  I  would  like  to  know  if  an  error  was  made  in  the 
report  of  the  committee  in  stating  that  only  Brazil  and  Chile  had  no 
compulsory  vaccination. 

Dr.  da  Rocha.  In  some  States  of  Brazil,  as  Sao  Paulo,  vaccina- 
tion has  been  made  compulsory;  but  it  is  not  so  in  other  States. 

Dr.  Guiteras.  Compulsory  vaccination  in  the  United  States  exists 
only  indirectly.  For  instance,  children  attending  school  must  be  vac- 
cinated. 

(The  motion  was  referred  to  the  Executive  Committee.) 

A  report  was  then  read  from  the  Committee  on  Sanitation  of  Ports 
and  Frontier  Towns  recommending  the  adoption,  with  slight  modifi- 
cations, of  Sr.  Ulanes'  motion  on  water  supply  and  sewer  system  in 
towns.     (See  Appendix.) 

(The  motion  was  referred  to  the  Executive  Committee.) 

Another  report  was  read  from  the  same  committee,  recommending 
the  approval  of  a  motion  from  Dr.  Vial.     (See  Appendix.) 

(There  being  no  discussion,  the  motion  was  referred  to  the  Execu- 
tive Committee.) 

A  report  was  then  read  from  the  Committee  on  Plague,  recommend- 
ing the  approval,  with  slight  modifications  of  four  motions  submitted, 
respectively,  by  the  Delegations  from  Bolivia,  Cuba,  and  Paraguay, 
and  the  Chilean  Delegate,  Dr.  Davila  Boza.     (See  Appendix.) 

Dr.  Roberts.  In  the  motion  by  the  Cuban  Delegation,  dessatization 
is  provided  for  indemne  ships  and  not  for  the  contaminated  ones. 
The  program  referred  to  the  systematic  dessotization,  but  not  in  case 
of  plague.  The  recommendation  had  already  been  made  by  the  last 
Conference,  and  experience  has  shown  us  that  nothing  is  gained  with 
mere  recommendations. 

Dr.  Sanjines.  I  accept  with  pleasure  the  amendment  proposed  by 
the  committee  to  the  motion.  I  was  aware  beforehand  that,  as  cus- 
tomary, the  assembly  would  word  my  motion  in  general  terms.  If  a 
had  made  particular  references  in  my  motion,  regarding  specially  the 
sanitation  of  the  ports  of  Arica,  Antofagasta  and  Mejillones,  it  was  in 
order  to  emphasize  my  point,  because  in  my  capacity  as  Bolivian  Dele- 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  51 

gate  it  is  my  duty  to  prevent  the  invasion  of  infectious  diseases  into 
Bolivia.  I  am,  therefore,  pleased  with  the  modification  suggested  by 
the  committee,  and  I  hope  the  Conference  will  accept  the  motion. 

Dr.  Illanes.  I  wish  to  give  some  information  regarding  the  sani- 
tation works  in  the  ports  of  Arica,  Mejillones,  and  Antofagasta,  which 
bear  relation  to  the  proposition  of  the  Delegate  from  Bolivia  and  the 
report  thereupon,  because  of  the  reference  made  in  said  proposition 
to  the  ports  I  have  mentioned.  The  Government  of  Chile  devotes  its 
best  attention  to  the  improvement  of  those  ports. 

In  the  contract  for  the  construction  of  the  Arica-La  Paz  Railway, 
provision  is  made  for  the  laying  of  pipes  for  the  conduct  of  the  River 
Caracarami  waters,  taking  them  from  a  point  140  kilometers  away  from 
Arica.  These  waters  shall  be  used,  partly  for  the  exploitation  of  the 
railway,  and  partly  for  the  supply  of  the  city  and  port  of  Arica,  it 
being  estimated  that  the  capacity  of  the  water  supply  will  be  70  liters 
daily  per  inhabitant.  Besides,  in  the  plans  for  public  works  now  un- 
der the  consideration  of  Congress  and  which  if  passed  would  be  oper- 
ative next  year,  funds  are  appropriated  for  the  sewer  system  and  for 
the  water  supply  works  in  the  same  city,  which  funds,  together  with 
those  set  aside  for  like  works  in  the  city  of  Tacna,  will  amount  to 
2,200,000  pesos. 

In  regard  to  Mejillones,  the  Supreme  Government  called  for  bids 
on  the  construction  of  water  supply  works  and  sewer  system,  but  the 
proposals  submitted  were  accepted  because  none  of  them  met  the  re- 
requirements  prescribed.  The  Supreme  Government  continues  to  pay 
attention  to  the  construction  of  works  of  sanitation  of  that  town. 

In  Antofagasta  there  is  a  water  suppy  system,  owned  and  exploited 
by  a  private  concern,  but  the  Government  is  now  bent  on  improving 
the  service,  by  pranting  new  water  concessions  so  that  the  supply 
may  be  increased.  In  the  same  city  the  Government  is  carrying  on,  by 
contract,  the  consideration  of  the  sewer  system  and  water  supply  for 
public  use,  which  works  will  soon  be  completed. 

In  the  plan  for  public  works,  to  which  I  have  just  referred,  provi- 
sion is  made  for  the  construction  of  very  important  port  works  in 
Arica  and  Antofagasta  which  will  contribute  largely  to  the  improve- 
ment of  public  health  in  those  ports. 

I  wanted  to  give  this  information,  Mr.  President,  for  the  benefit  of 
the  Delegate  from  Bolivia  and  by  reason  of  the  justified  motives  con- 
tained in  the  motion  under  discussion.  If  the  Delegate  from  Bolivia 
should  desire  further  information,  I  shall  very  gladly  furnish  him  there- 
with. 

Dr.  Sanjines.  It  is  gratifying  for  me  to  state  that  I  am  highly 
satisfied  with  the  explanations  courteously  given  by  the  distinguished 
member  of  the  Chilean  Delegation ;  I  shall  be  pleased  to  transmit  this 
information  to  my  Government. 

(Without  further  debate,  the  motions  were  referred  to  the  Executive 
Committee.) 

The  motions  and  the  committee  reports  thereon  having  been  and 
discussed,  the  debate  was  then  taken  up  of  the  motions  which  the  Ex- 
ecutive Committee  had  decided  to  submit  to  the  consideration  of  the 
assembly. 


52  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

The  Conference  was  first  consulted  as  to  two  motions  presented  by 
Dr.  Amunategui.     (See  Appendix.) 

The  Delegates  from  Colombia  and  from  the  Dominican  Republic 
abstained  from  voting.  The  Delegation  of  Salvador  voted  in  the  nega- 
tive. All  the  other  Delegations  voted  affirmatively.  The  motions  were, 
therefore,  approved. 

Other  propositions  which  were  ready  for  submission  to  the  Assem- 
bly were  unanimously  approved.     (See  Appendix.) 

A  report  was  read  from  the  Committee  on  Cholera  recommending 
the  adoption  of  the  resolutions  appearing  in  the  Appendix. 

(There  being  no  discussion,  the  motions  were  referred  to  the  Execu- 
tive Committee.) 

Dr.  Fernandez  Espiro.  As  in  to-morrow's  session,  the  Conference 
will  select  the  seat  for  the  next  Conference,  the  Uruguayan  Delegation 
has  the  honor  to  propose  the  city  of  Montevideo  for  that  purpose. 

Dr.  Roberts.  In  the  name  of  Cuba  I  have  the  honor  to  propose  the 
city  of  Havana  as  the  seat  for  the  Sixth  Conference. 

The  President.  The  board  of  Directors  of  the  Medical  Society  has 
requested  me  to  invite  the  Conference  to  a  special  session  that  it  will 
hold  this  evening  at  which  we  will  have  the  pleasure  to  hear  the  lec- 
tures to  be  delivered  by  our  distinguished  colleagues,  Dr.  Araoz  Alfaro, 
of  Buenos  Aires,  and  Dr.  Ferrari,  of  Rio  de  Janeiro,  the  former  on 
cito-diagnosis,  and  the  latter  on  small-pox. 

Dr.  Araoz  Alfaro.  I  beg  to  submit  a  motion  recommending  the 
next  Conference  "the  study  of  epidemic  cerebro-spinal  meningitis  and 
of  anterior  transmissible  poly-mielitis." 

(This  motion  was  referred  to  the  Executive  Committee.) 
(The  session  adjourned  at  4.30  p,  m.) 


SEVENTH  DAY— SATURDAY,  NOVEMBER  11,  1911. 
Morning  Session. 

The  Conference  was  called  to  order  at  10  A.M.  by  the  President, 
Dr.  Alejandro  del  Rio,  all  the  Delegations,  except  the  Hondurean, 
being  present.  By  request  of  the  President,  Dr.  Ortega,  of  Guate- 
mala, and  Dr.  Lizoni,  of  the  Dominican  Republic,  sat  at  the  Presi- 
dential table  in  their  capacity  as  Vice-Presidents  of  the  Conference. 

The  minutes  of  the  penultimate  session  were  read  and  approved. 

The  Secretary,  Dr.  Amunategui,  transmitted  to  the  Delegates 
an  invitation  from  Sr.  Justino  Pelle  to  visit  the  model  slaughterhouse 
of  Valparaiso. 

The  President.  The  representative  from  the  Pan-American 
Union,  Captain  Granville  R.  Fortescue,  has  the  floor. 

Captain  Fortescue.  Mr.  President  and  Delegates :  I  bring  warm- 
est greetings  from  the  Pan  American  Union  in  Washington  and  felici- 
tations with  best  wishes  for  a  successful  convention  from  my  chief, 
the  director  general,  Mr.  John  Barrett,  than  whom  there  is  no  more 
loyal  supporter  of  Latin  American  interests. 

I  come  to  you  not  as  a  North  American,  but  as  a  Pan  American. 

Lack  of  technical  education  forbids  my  addressing  you  to-day  along 
the  lines  of  the  special  and  most  important  work  which  has  called 
you  here ;  that  has  been  ably  done  by  my  esteemed  colleagues,  Drs. 
Gregorio  Guiteras  and  J.  C.  Perry,  whom  we  have  heard  with  interest. 

As  you  are  good  Americans  first  and  scientists  afterwards,  I  shall 
speak  on  a  subject  that  should  claim  the  interest  of  all  Americans 
be  they  born  in  Chile  or  Colombia,  Argentina,  or  the  United  States, 
Brazil,  or  Bolivia,  or  in  any  other  of  the  sturdy  nations  of  our  hemi- 
sphere.    This  subject  is  the  Pan  American  Ideal. 

Those  who  have  given  thought  to  the  progress  of  civilization  can 
not  but  have  been  impressed  with  the  rapid  advance  that  has  charac- 
terized the  cause  of  humanity  during  the  last  10  years,  an  advance 
which  perhaps  owes  its  greatest  stimulus  to  the  activity  of  the  mem- 
bers of  your  profession.  No  longer  is  the  cruel  doctrine  of  the 
survival  of  the  fittest  tenable — now  we  advance  the  more  humane 
theory  of  aid  to  the  weaker,  and  those  who  through  adversity,  mis- 
fortune, or  illness,  find  themselves  handicapped  in  the  struggle  for 
existence,  are  not  trampled  under  foot  but  instead  receive  the  kind 
hand  of  brotherhood,  which  helps  them  to  bear  more  equably  their 
burdens.  No  longer  do  we  see  in  our  neighbor's  misfortune  the 
quickly  to  be  seized  opportunity  for  our  own  advancement. 

The  spirit  of  the  age  is  what  has  been  aptly  called  the  Christian 
spirit,  which,  liberally  interpreted,  means  that  we  must  meet  all  men 
on  the  broad  ground  of  unselfish  consideration.  Granting  this  gradual 
change  which  is  being  brought  about  by  the  force  of  public  opinion 


54  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

in  the  relations  between  man  and  man,  why  is  it  not  a  logical  sequence 
to  apply  this  principle  to  the  relations  between  nations?  Nations  are 
but  collections  of  individuals,  having  the  same  ambitions,  passions, 
emotions  of  the  unit  human  being,  and  thus  it  should  follow  that 
when  the  plane  of  thought  of  the  members  of  society  is  brought  to  a 
higher  level,  when  the  necessity  of  mutual  interdependence  is  generally 
recognized,  the  fellowship  of  nations  should  become  a  fact. 

The  fellowship  of  nations.  That  is  the  Pan  American  ideal.  A 
joining  together  in  bonds  of  mutual  understanding  of  all  the  Repub- 
lics of  this  half  of  the  world.  How  are  we  to  arrive  at  this  much 
to  be  desired  end?  First,  by  promoting  personal  intercourse,  by 
becoming  better  acquainted ;  and  second,  by  letting  the  old  hatreds 
die.  We  of  the  northern  Republic  must  make  the  opportunity  that 
will  lead  to  closer  relations  with  you  of  the  Latin  countries.  This 
we  will  do  with  the  completion  of  the  Panama  Canal.  The  stimulus 
to  travel  that  is  bound  to  follow  this  event  can  not  but  help  leading 
to  an  era  of  good  feeling.  We  will  learn  of  your  glorious  history, 
your  heroes,  your  magnificent  resources,  and  your  steady  social  and 
economic  progress,  while  you  will  meet  Yankees  who  do  not  worship 
at  the  shrine  of  the  dollar.  Not  that  I  deprecate  commerce;  quite 
the  contrary ;  commerce  and  comity  are  allied  forces  on  the  side  of 
mutual  better  understanding. 

It  is  known  that  trade  is  one  of  the  best  mediums  by  which  it  is 
possible  to  gain  a  correct  appreciation  of  the  other  man's  point  of 
view.  As  such  an  appreciation  is  absolutely  essential  in  order  to 
combat  the  intolerance  of  ignorance,  it  is  only  natural  that  an  institu- 
tion which  aims  at  the  attainment  of  these  ideal  national  relations  that 
I  have  depicted  should  bend  its  energies  to  the  promotion  of  every 
legitimate  means  of  increasing  commercial  activity.  And  as  a  cor- 
ollary to  this  trade  movement  there  will  be  that  most  necessary  work 
which  is  the  chosen  field  of  you  gentlemen.  In  your  positions  as 
guardians  of  the  health  of  the  peoples  it  would  seem  that  innumerable 
opportunities  would  present  themselves  wherein  it  would  be  possible 
to  advance  the  Pan  American  ideal. 

I  may  say  here  that  without  your  aid,  without  the  highest  state  of 
sanitation  in  all  our  ports,  it  would  be  impossible  to  develop  new 
trade  routes  to  their  perfection.  The  fight  against  disease  which  you 
are  so  successfully  waging  has  opened  the  door  to  worlds  heretofore 
considered  closed  to  the  white  man.  The  fever-stricken  jungles  that 
had  been  given  over  to  the  occupation  of  wild  birds  and  beasts  alone, 
will  by  the  magic  aid  of  sanitation  develop  into  lands  which  will 
support  the  countless  millions  of  future  generations. 

Again,  sanitation  has  reduced  the  perils  from  disease  in  traveling 
to  a  minimum,  it  has  raised  the  standard  of  cleanliness  among  all 
nations,  and  it  has  made  for  an  advance  in  civilization  by  promoting 
the  self-respect  of  those  who  practice  its  precepts.  These  are  only 
a  few  of  the  results  of  your  labors,  but  they  have  been  strong  causes 
in  the  promotion  of  the  unity  of  nations. 

The  condition  which  I  have  placed  as  the  second  factor  in  bringing 
about  the  perfect  understanding  among  the  western  Republics  is  "to 
let  old  hatreds  die."     It  is  a  fact  that  our  judgments  of  past  events 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  55 

as  historically  set  forth  have  undergone  many  changes,  and  it  is  signi- 
ficant, in  my  country  at  least,  that  we  are  revising  our  history  books. 
No  longer  is  it  considered  necessary  to  breed  bitter  hate  in  the  hearts 
of  our  school  children  against  England  because  the  soldiers  of  King 
George  fought  our  forefathers.  Again,  the  story  of  the  four  long 
years  of  civil  strife,  which  divided  my  people  in  acrid  antagonism, 
is  now  told  with  careful  impartiality.  Of  course,  the  extreme  partisan 
still  lives ;  that  is  to  be  expected.  But  it  is  with  a  changed  spirit  that 
we  read  of  those  incidents  which  were  wont  to  arouse  our  suspicions 
against  all  other  countries,  and  made  us  look  upon  them  as  implacable 
rivals.  Suspicion  is  the  parent  of  much  misunderstanding.  Let  us 
have  done  with  it.  The  Latin  American  nations  have  a  glorious  his- 
torical heritage.  From  the  days  of  early  discovery,  when  those  who 
came  first  suffered  untold  hardships,  through  the  brilliant  period  that 
led  to  independence,  the  American  has  given  proof  of  high  standards 
of  honor  and  bravery  on  many  occasions.  O'Higgins,  Bolivar,  San 
Martin,  Sucre,  and  Washington  are  names  ever  enshrined  high  among 
the  world's  array  of  heroes. 

But  it  is  not  only  military  records  that  spell  the  fame  of  the  Ameri- 
can Republics.  "Peace  hath  her  victories  no  less  renowned  than 
war,"  as  has  been  proved  by  the  record  of  achievement  standing  to 
their  credit  at  The  Hague  Conference. 

And  if  more  proof  were  wanted  to  show  that  the  Pan  American 
nations  stood  shoulder  to  shoulder  in  the  front  rank  of  the  world's 
peace  movement,  I  would  point  to  that  monument  which  stands  high 
up  above  the  clouds  of  Uspallata,  "The  Christ  of  the  Andes."  A 
peace  monument  that  puts  before  the  world  the  unsurpassed  example 
of  the  forbearance,  the  moderation,  the  unselfishness  of  two  great 
nations.  And  there  at  the  base  of  that  statue  is  inscribed  the  words 
that  should  be  the  inspiration  of  all  countries:  "Rather  that  these 
mountains  should  crumble  to  dust  than  that  nation  should  arm  against 
nation."     That  is  the  Pan  American  ideal. 

Senor  Alfonso.  Mr.  President,  Messrs.  Delegates :  It  is  not  every 
day  that  we  have  the  privilege  of  listening  to  such  refreshing  and 
comforting  expressions.  The  remarks  we  have  just  heard  are  phil- 
osophy ;  they  are  benevolence ;  they  are  morality.  There  is  an  inferior 
consciousness  of  own  interests  that  leads  us  to  compete  by  vexatious 
methods  with  our  supposed  adversaries.  But  there  is  a  superior 
realization  of  those  very  interests  that  leads  us  to  discover  the  great 
harmonies  that  there  may  exist  among  the  various  interests  of  men, 
and  to  unite  our  efforts  in  the  struggle  against  hostile  nature,  against 
vice,  ignorance  and  error.  This  superior  consciousness  of  human 
interests  enlightens  first  in  the  minds  of  great  men  and  great  nations. 
What  a  great  truth  there  is  in  that  saying  that  "when  the  sun  rises 
it  shines  first  upon  the  hills." 

The  scientists,  monarchs  of  mind,  without  scepter  nor  crown,  out- 
line the  courses  to  be  followed  by  humankind,  and  the  advanced  gov- 
ernments co-operate  with  them  in  the  furtherance  of  the  civilizing 
activities. 

The  natural  development  of  our  life  offers  by  itself  enough  misery, 
trouble  and  pain,  which  we  should  not  increase  by  antagonizing  our- 


56  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

selves  mutually ;  on  the  contrary,  such  miseries,  troubles  and  pains 
should  stimulate  us  in  uniting  our  hearts,  minds  and  wills  for  the 
best  sake  of  the  welfare  and  improvement  of  humankind. 

There  is  not  an  instant  in  the  extensive  history  of  the  world  in 
which  the  idea  of  progress  has  not  continued  to  realize  itself,  in 
which  the  idea  of  progress  has  not  been  in  execution  in  the  midst  of 
all  activities  of  life ;  and  of  all  progresses  the  most  substantial  and 
important  one  is  the  moral  progress  that  irradiated  from  a  cross  at 
the  hill  of  Calvary.  As  you  have  just  heard,  that  moral  progress 
has  erected  on  the  Andes  the  monument  to  the  Savior  which  sym- 
bolizes the  reconciliation  and  friendship  of  two  sister  nations.  That 
moral  progress  is  the  greatest  comfort  and  hope  of  humankind. 

Science  contributes  in  a  very  large  measure  to  that  moral  progress, 
just  as  it  sheds  light  upon  our  paths  and  guides  our  steps.  Faith 
is  the  lever  of  that  progress ;  I  do  not  refer  to  a  given  religious  faith, 
but  to  that  faith  that  invigorates  the  spirit  upon  the  consideration  of 
all  great  ideals,  and  which  creates  heroic  minds  in  the  struggle  for 
welfare.     All  is  harmony ;  all  is  solidarity. 

Material  progresses  that  facilitate  and  improve  life  contribute 
towards  such  harmony  and  solidarity.  Through  innumerable  diffi- 
culties, the  Republic  of  our  continent  strive  to  consolidate  their 
thoughts,  their  feelings  and  their  destinies.  The  nature  of  historical 
events  has  accorded  our  great  sister  of  the  North  an  actual  promi- 
nence, the  acknowledgment  of  which  is  no  obstacle  to  other  regards 
and  considerations,  and  it  shall  not  be  taken  advantage  of  to  the 
detriment  of  the  other  Republics,  but  for  the  sake  of  mutual  solidarity 
and  progress,  specially  when  the  titanic  work  of  Panama  shall  have 
untied  the  Isthmian  knot  and  united  both  oceans. 

We  have  heard  words  of  logical  ideality  and  progress  which  invite 
us  to  rise  of  our  hearts  and  minds.  We  are  grateful  for  those  words 
on  account  of  their  own  value  and  of  what  they  mean  to  the  future. 

(Several  reports  from  the  Executive  Committee  on  different  mo- 
tions were  then  read.  The  text  of  the  resolutions  adopted  appears 
in  the  Appendix.) 

Dr.  Araoz  Alfaro.  What  was  the  outcome  of  the  motion  pre- 
sented by  the  Venezuelan  Delegation  in  regard  to  the  prophylaxis 
of  malaria? 

The  President.  The  Executive  Committee  did  not  submit  it  to 
the  consideration  of  the  Conference  because  it  recommends  the  adop- 
tion of  the  Simla  Conference,  the  text  of  which  that  body  has  not 
seen.  Likewise,  there  are  other  motions  which  have  not  been  ap- 
proved by  that  Committee  and  have  not  been,  therefore,  submitted  to 
the  Assembly.  The  Executive  Committee  has  taken  such  action  on 
ground  which  it  deemed  sufficient. 

We  will  now  proceed  with  the  designation  of  the  place  where  the 
next  Conference  shall  be  held. 

The  Secretary,  Dr.  Amunategui.  Having  consulted  a  large 
majority  of  the  Delegates  in  regard  to  this  point,  I  have  the  honor 
to  move,  on  behalf  of  the  Chilean  Delegation,  that  the  city  of  Monte- 
video, Uruguay,  be  selected  as  the  place  for  the  next  meeting.  (The 
motion  is  carried.) 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  57 

Dr.  Da  Rocha.  As  I  feel  sure  that  I  am  voicing  the  desire  of  the 
Delegates,  I  have  the  honor  to  move  that  Dr.  Fernandez  Espiro  be 
appointed  President  of  the  next  Conference. 

(The  motion  is  carried  by  unanimous  acclamation.) 
Dr.  Roberts.  I  am  sorry  not  to  have  been  able  to  secure  the  floor 
beforehand.  It  was  my  desire  to  state  that,  having  consulted  the 
other  Delegates  and  having  convinced  myself  that  the  majority  of 
them  preferred  to  designate  Montevideo,  in  deference  to  that  desire, 
I  intended  to  move  that  that  place  be  designated  by  acclamation. 

Dr.  Guiteras.  The  U.  S.  Delegation  had  seconded  the  motion 
presented  by  Dr.  Roberts  to  the  effect  that  Havana  be  selected  as  the 
place  for  the  next  meeting,  I  must  now  say  that  it  is  with  great 
pleasure  that  I  accept  the  offer  made  by  the  Uruguayan  Delegation. 

The  President.  In  view  of  the  unanimous  acceptance  by  the  Dele- 
gations, the  city  of  Montevideo  is  designated  as  the  place  for  the  next 
Conference. 

Dr.  Fernandez  Espiro.  The  Uruguayan  Delegation,  in  behalf  of 
the  Government  and  in  its  own  name,  sincerely  thanks  the  Conference 
for  the  honor  conferred  upon  our  capital  city.  It  also  thanks  the 
Cuban  Delegate,  as  well  as  the  United  States  Delegate,  for  their  kind 
words.  I  also  express  our  appreciation  to  the  Delegate  from  Brazil. 
The  President.  It  is  now  in  order  to  appoint  the  members  of  the 
International  Sanitary  Bureau  of  Washington,  and  in  this  connection 
I  have  the  honor  to  move  that  the  honorable  General  Wyman  be 
re-elected  as  the  Chairman  thereof. 

(This  motion  was  unanimously  carried  in  the  midst  of  prolonged 
applause.) 

Dr.  Guiteras.  In  behalf  of  the  United  States  Delegation,  I  wish 
to  thank  the  President  and  the  Delegates  for  the  honor  they  have 
conferred  upon  my  nation  and  General  Wyman  re-electing  him  as 
Chairman  of  the  International  Sanitary  Bureau  of  Washington. 

I  beg  to  add  that  General  Wyman  watches  with  the  keenest  interest 
the  progress  of  this  Conference.  He  has  it  at  heart;  he  wished  to 
attend  it,  but  unforseen  circumstances  prevented  him  from  having 
that  pleasure. 

The  President.  As  my  motion  has  been  carried  with  the  unani- 
mous acceptance  so  expressively  accorded  it,  I  shall  have  the  honor 
to  advise  General  Wyman  by  cable.  It  is  now  in  order  to  elect  the 
six  members  that  are  to  constitute  the  Bureau. 

The  Delegates  then  went  into  conference,  to  agree  on  the  names  to 
be  voted  upon,  and  upon  returning,  Dr.  Araoz  Alfaro  presented  the 
following  list,  which  was  approved  by  acclamation : 

Dr.  Oscar  Dowling,  of  the  United  States  of  America. 
Dr.  Eduardo  Liceaga,  of  Mexico. 
Dr.  Hugo  Roberts,  of  Cuba. 
Dr.  Salvador  Ortega,  of  Guatemala. 
Dr.  Luis  Razetti,  of  Venezuela. 
Dr.  Alejandro  del  Rio,  of  Chile. 
Dr.  Roberts.     The  Cuban  Delegation  thanks  the  Conference  most 
sincerely  for  the  honor  it  has  conferred  upon  me.     But  I  must  state 
that   there  are   in   Cuba  eminent   scientists   who  can   undoubtedly  fill 


58  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

that  position  with  greater  ability  than  mine,  particularly  Dr.  Juan 
Guiteras,  our  Director  of  Health,  whose  name  I  had  proposed  for 
the  place. 

Dr.  Cornejo.  Referring  to  a  motion  that  I  had  the  honor  to 
submit  and  which  the  Executive  Committee  did  not  see  fit  to  report 
to  the  Conference,  I  request  that  the  following  statement  be  read 
into  the  minutes: 

"The  Ecuadorian  Delegation  submitted  in  due  time  a  motion  which, 
I  suppose,  has  been  taken  into  consideration  by  the  Executive  Com- 
mittee, because  yesterday  there  was  approved  a  motion  similar  to  my 
proposition  which  call  the  attention  of  the  governments  that  signed 
the  Washington  Convention  the  necessity  of  harmonizing  the  maritime 
health  regulations.  But  as  neither  in  yesterday's  session  nor  in 
to-day's,  which  is  the  last  one,  has  it  been  reported  to  the  Conference, 
I  beg  to  state :  That  in  submitting  that  motion,  the  Ecuadorian  Dele- 
gation only  had  in  mind  to  inform  the  Assembly  the  extreme  sanitary 
restrictions  to  which  the  arrivals  from  Ecuador  are  subjected,  to  the 
detriment  of  our  commerce,  and  without  regard  to  the  Convention  of 
Washington.  On  the  other  hand,  it  is  only  proper  that  motions  should 
be  reported  upon,  whethey  they  be  acceptable  or  not. 

Perhaps,  the  motion  by  the  Ecuadorian  Delegation  might  be  re- 
garded as  partial,  that  is  to  say,  as  not  being  couched  in  general  terms. 
But  in  my  opinion  it  is  not  so,  because  if  the  terms  of  said  motion 
have  some  reference  to  the  present  situation  in  Ecuador,  it  could  have 
been  so  worded  as  to  meet  the  demands  of  the  Conference.  And  a 
simple  suggestion  from  the  honorable  Executive  Committee  would 
have  been  sufficient  for  the  Ecuadorian  Delegate  to  draft  his  motion 
in  more  general  terms." 

I  have  diverted  the  attention  of  the  Conference  with  this  statement 
in  order  to  inquire  if  all  the  motions  submitted,  including  mine,  will 
appear  in  full  in  the  book  that  is  going  to  be  edited  in  the  United 
States,  containing  the  transactions,  resolutions  and  motions  of  this 
Conference.  At  any  rate,  I  repeat  that  I  wish  that  the  foregoing 
statement  be  inserted  verbatim  in  the  minutes.  Before  closing,  I  will 
request  the  President  to  state  whether  or  not  the  motions  submitted 
by  the  Delegates  are  to  be  published  in  the  transactions  in  their  orig- 
inal form. 

The  President.  The  Delegate  from  Ecuador  desires  the  state- 
ment he  has  just  read  to  be  inserted  in  the  minutes.  The  Chair  has 
no  objection  thereto,  and  has  the  pleasure  to  so  order  it. 

Dr.  Cornejo.  I  request  the  President  to  tell  me  whether  the  mo- 
tions will  be  published  in  their  original  form. 

The  President.  Regarding  that  point,  I  must  say  that  the  mo- 
tions approved  by  the  Assembly  in  accordance  with  the  rules  and  with 
the  practice  constantly  followed  shall  be  promulgated  in  the  shape 
given  the  mby  the  Executive  Committee  when  reporting  them  to  the 
Assembly. 

Dr.  Cornejo.  I  do  not  refer  to  the  resolution  of  the  Conference, 
which,  of  course,  shall  be  published  just  as  they  may  be  passed. 
What  I  wish  to  know  is  whether  the  motions  presented  by  the  different 
delegates  are  to  be  inserted  in  the  minutes  in  their  exact  original  form, 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  59 

whatever  the  action  taken  thereon.  In  my  opinion,  such  an  insertion 
would  imply  no  inconvenience,  but,  on  the  contrary,  it  would  serve 
to  give  a  full  and  correct  idea  of  the  subjects  discussed,  and  it  would 
also  help  in  the  construction  of  the  resolutions  and  other  acts  of  the 
Conference. 

The  President.  With  the  explanation  given  by  the  Delegate,  I 
understand  that  his  desire  is  that  the  original  motions  should  be 
inserted  in  the  transactions  as  a  matter  of  record,  so  they  may  serve 
to  give  a  true  history  of  the  transactions,  discussions  and  votes  of 
the  Conference.  In  that  sense,  the  chair  has  no  objection,  but,  on 
the  contrary,  it  makes  it  a  duty  to  move  that  the  motions  submitted 
be  published  in  their  original  form  in  the  transactions. 

Dr.  Cornejo.  I  thank  the  President,  as  I  also  thank  the  Execu- 
tive Committee,  which,  although  it  abstains  itself  from  submitting  to 
the  consultation  of  the  assembly  the  motion  that  I  presented,  and  to 
which  I  referred  a  few  moments  ago,  it  has  approved  it  implicitly, 
because  it  withheld  it  on  account  of  a  matter  of  form. 

The  President.  Of  course,  the  Executive  Committee  must  see 
to  it  that  all  motions  are  couched  in  general  terms,  that  is  to  say, 
that  they  should  not  have  a  local  object  in  view  and  limited  only  to  a 
country  or  two.  Otherwise,  the  idea  contemplated  in  the  Ecuadorian 
Delegate's  motion  is  within  the  strict  observance  of  the  Washington 
Convention. 

Dr.  Cornejo.  Exactly;  and  I  so  state  it  in  the  remarks  I  have 
submitted  in  writing. 

Dr.  Araoz  Alfaro.  I  move  that  General  Doctor  da  Rocha  be 
designated  to  speak,  in  the  name  of  all  the  Delegations,  at  the  closing 
session  that  is  to  be  held  this  afternoon.  He  will  interpret  faithfully 
our  feelings  and  will  express  eloquently  our  appreciation  of  the 
magnificent  hospitality  and  kindness  that  have  been  extended  to  us. 

(The  motion  was  unanimously  carried.) 

Dr.  da  Rocha.  Accepting  the  honorable  commission  with  which 
I  have  been  undeservingly  honored,  to  express  sentiments  of  the 
Delegations  upon  taking  farewell,  I  request  that  special  mention  be 
made  in  the  minutes  of  the  profound  gratitude  with  which  I  receive 
this  additional  proof  of  the  Argentine  Delegation  kindness  upon  mov- 
ing that  I  be  designated  for  that  purpose. 

The  President.  We  shall  now  proceed  with  the  reading  of  the 
lists  of  the  information  committees.  I  am  sorry  to  say  that  the  list 
is  not  a  complete  one,  because  there  still  is  lacking  the  Committees  of 
several  countries. 

The  Secretary,  Dr.  Amunategui,  read  the  list  referred  and  stated 
that  the  Committees  of  the  Argentine  Republic,  Brazil  and  Paraguay 
are  missing. 

Dr.  Ferrer.  It  should  be  borne  in  mind  that  these  appointments 
are  made  ad  referendum,  as  they  are  to  be  submitted  to  the  approval 
of  the  respective  Governments. 

Dr.  Monjaras.  The  appointment  of  these  Committees  should  be 
made  by  the  respective  Delegations.  It  should  be  remembered  that 
the  members  appointed  should  be  public  officers. 

Dr.   Araoz  Alfaro.     I  move  that  appointment  of   the  Argentine 


60  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

Committee  foe  left  to  the  Government  of  my  country,  to  which  I  shall 
convey  the  desire  of  the  Conference. 

Dr.  da  Rocha.  I  make  the  same  statement  with  regard  to  the 
Brazilian  Committee. 

Dr.  Corbalan.  I  am  informed  that  several  of  the  members  ap- 
pointed on  the  information  committees  have  ceased  to  be  public  officers 
and  they  should  therefore  be  replaced.  This  is  an  important  point, 
because  it  is  connected  with  the  services  of  the  different  countries. 

Dr.  Fernandez  Espiro.  This  same  question  has  been  discussed 
on  other  occasions.  Some  Delegates  stated  that  they  were  authorized 
to  make  the  appointments  for  the  respective  committees,  while  others 
said  that  they  were  not  provided  with  such  authority.  I  was  in  this 
latter  case,  and  I  suggested  that  the  Delegates,  upon  returning  to  their 
countries  should  take  up  with  their  respective  Governments  the  matter 
of  organizing  officially  the  Information  Committees.  It  was  so  done 
in  my  and  other  countries.  I  believe  that  this  same  procedure  should 
now  be  followed.  That  is  to  say,  that  the  Delegations  having  full 
powers  from  their  Governments  to  make  the  appointments,  may  do 
so  now ;  and  those  not  having  it  should  request  their  Government  to 
organize  their  own  committees. 

Dr.  Guiteras.  I  believe  it  would  be  proper  to  notify  the  Interna- 
tional Sanitary  Bureau  of  Washington  when  the  Committees  now 
lacking  are  duly  organized,  so  that  the  names  of  the  appointtees  may 
be  published  in  the  Transactions  of  this  Conference.  (General 
approval.) 

Dr.  Ferrer.  I  take  advantage  of  this  opportunity  to  move  that  a 
vote  of  remembrance  be  taken  in  honor  of  two  gentlemen  intimately 
connected  with  these  Conferences  and  their  growing  success.  We 
have  already  given  a  vote  of  applause  to  General  Wyman  by  the 
significant  action  of  reappointing  him  once  more  to  the  Chairmanship 
of  the  International  Sanitary  Bureau.  I  think  it  is  also  our  duty  to 
send  our  greetings  to  Dr.  Liceaga,  of  Mexico,  President  of  the  Third 
Conference,  and  to  Dr.  Juan  Jose  Ulloa,  of  Costa  Rica,  permanent 
Secretary  of  first  Conferences,  and  President  of  the  last  one  held  in 
San  Jose  de  Costa  Rica.  The  affectionate  remembrance  that  I  pro- 
pose is  for  those  two  gentlemen. 

(The  motion  was  carried  by  general  acclamation.) 

Dr.  Monjaras.     I  beg  to  submit  the  following  votes  of  thanks : 

1st.  That  the  most  expressive  thanks  of  the  Conference  be  tendered 
to  the  people  and  Government  of  Chile,  and  specially  to  the  President 
of  the  Republic  and  the  Minister  for  Foreign  Affairs,  for  the  numerous 
and  kind  attentions  extended  to  the  Delegates  from  the  nations  here 
represented. 

2d.  To  the  Santiago  society  for  the  attentions  that  we  have  received 
from  them. 

3d.  To  the  Argentine  Legation  near  the  Government  of  Chile  for 
the  reception  to  which  the  Delegates  were  invited. 

4th.  To  the  Chilean  Delegation,  which  so  kindly  has  made  so  pleas- 
ant the  sojourn  of  the  Delegates  from  the  other  nations. 

5th.  To  the  President  of  the  Conference,  Dr.  Alejandro  del  Rio, 
for  the  beautiful  garden  party  which  he  gave  in  honor  of  the  Dele- 
gates in  his  residence,  "Villa  Maria." 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  61 

6th.  To  the  directors,  administrators  and  professors  of  the  scientific 
and  charitable  institutions  which  have  so  courteously  received  us. 

Dr.  Razetti.  The  Venezuelan  Delegation  had  drafted  a  resolu- 
tion which  I  will  not  read  because  it  is  similar  to  that  presented  by  the 
Mexican  Delegate. 

Dr.  da  Rocha.  I  move  that  'there  be  added  a  vote  of  thanks  to 
the  press  of  this  capital. 

Dr.  Monjaras.  I  propose  still  another  vote  of  thanks,  that  is  to 
the  Intendent  and  First  Mayor  of  Valparaiso  for  the  invitation  he 
tendered  to  the  Delegates  to  visit  that  city  and  the  Penuelas  Water 
Works. 

(All  the  above  motions  were  unanimously  carried.) 

Dr.  Asta-Buruaga.  In  behalf  of  the  Chilean  Delegation,  I  move 
that  the  Conference  extend  its  thanks  to  the  Bolivian  Delegate  for 
the  banquet  which  he  gave  in  the  Club  Union. 

Dr.  da  Rocha.  I  request  the  following  statement  be  read  into 
the  minutes : 

The  Delegation  from  the  United  States  of  Brazil  wishes  that  record 
should  be  left  in  the  Transactions  of  the  Fifth  International  Sanitary 
Conference,  of  the  successful  results  which,  for  the  sanitary  defense 
of  the  Brazilian  ports,  have  been  obtained  by  the  strict  compliance 
with  the  provisions  contained  in  the  Sanitary  Convention  of  June  22, 
1904,  signed  in  Rio  de  Janeiro  by  the  Plenipotentiaries  from  the 
Argentine  Republic,  Uruguay,  Paraguay  and  Brazil,  respecting  at  the 
same  time  the  provisions  of  Washington  Convention  and  amend- 
ments. Santiago  de  Chile,  November  11,  1911.  Dr.  Ismael  da 
Rocha.     Dr.  Antonio  Ferrari. 

The  Secretary,  Dr.  Amunategui.  To  the  closing  session  that 
will  be  held  this  afternoon  at  four  o'clock,  the  Delegates:  and  their 
families  and  the  Diplomatic  representations  of  the  American  Repub- 
lics have  been  invited.  As  this  invitation  has  been  made  at  a  late 
hour,  the  Delegates  are  requested  to  extend  it  to  their  respective 
Ministers. 

It  being  probable  that  ladies  will  be  present  at  the  closing  session, 
at  which  the  resolutions  passed  will  be  read,  I  request  the  Assembly 
to  let  that  regarding  prostitution  to  be  read  now.  (Resolution  X,  ap- 
pearing on  page  68,  was  read.) 

The  session  adjourned  at  12  M. 

Afternoon — Closing  Session. 

At  four  o'clock,  assembled  in  the  Hall  of  Honor  of  the  University, 
the  Fifth  Conference  held  the  closing  session,  Dr.  Alejandro  del  Rio, 
presiding.  To  his  right  seated  Dr.  Fernandez  Espiro,  from  Uruguay, 
President  of  the  Sixth  Conference,  and  Dr.  Acosta  Ortiz,  of  Vene- 
zuela. The  Secretaries,  Dr.  Amunategui,  Dr.  Perry  and  Dr.  Razetti, 
also  sat  at  the  President's  table. 

The  Secretary,  Dr.  Amunategui,  read  the  resolutions  passed  by 
the  Conference  (see  Appendix,  pages  68  and  69). 

Dr.  Fernandez  Espiro  thanked  the  Conference  for  designating  the 
city  of  Montevideo  as  the  seat   for  the   Sixth  Conference,  and  the 


62  FIFTH   INTERNATIONAL  SANITARY   CONFERENCE. 

Chilean  Delegation  for  making,  through  Dr.  Amunategui,  the  motion 
to  that  effect. 

Dr.  da  Rocha  then  took  the  floor  and  delivered  the  farewell  speech 
in  behalf  of  the  Delegates.  He  began  by  saying  that  the  farewell  may 
be  divided  into  three  parts,  to  wit:  to  the  American  Delegates,  to 
Uruguay,  and  to  Chile.  With  respect  to  the  first  he  pointed  out 
the  fact  that  the  American  Eagle  bears  this  motto :  E  Pluribus  Unum, 
which  means  all  united,  and  which  amplified  could  be  applied  to  sci- 
ence, to  progress,  to  hope  and  to  force  for  'the  defense  of  national 
honor  whenever  necessary.  He  then  moved  that  a  greeting  be  sent 
to  the  American  Nation,  which  gallantry  wrote  the  words  "America 
for  the  Americans."  As  to  Uruguay,  he  congratulated  that  country 
for  having  been  seleoted  for  the  seat  of  the  next  Conference,  a  very 
fitting  selection,  because  it  is  the  country  with  the  smallest  death 
rate,  that  is  to  say,  15  per  cent.  He  then  repeated  the  phrase  of 
Francisco  de  Saca,  an  eminent  Uruguayan,  "Peoples  must  be  learned 
or  else  die."  With  regard  to  Chile,  he  quotes  from  a  geography 
written  by  his  daughter,  Miss  da  Rocha,  a  description  of  that  country. 
He  closes,  saying  that  the  Brazilian  Delegates  will  not  return  to  their 
country  by  way  of  the  Andes,  but  by  that  of  the  Pacific  around  Punta 
Arenas  so  as  to  become  acquainted  with  its  coast. 

The  President.  Ladies  and  Gentlemen :  I  will  occupy  your  atten- 
tion for  a  short  time  only.  I  only  wish  to  express  in  behalf  of  the 
Chilean  Delegation  our  sincere  and  affectionate  esteem  of  yourselves, 
whom  we  have  learned  to  love  during  our  common  labors. 

The  friendship  created  on  this  occasion  will  serve,  undoubtedly,  to 
facilitate  the  practical  application  of  our  acts  and  resolutions,  taking 
into  consideration  the  high  representation  with  which  you  are  in- 
vested and  your  influence  near  the  respective  Governments.  A  similar 
influence  will  certainly  serve  to  facilitate  the  action  of  the  information 
committees.  It  has  been  a  matter  of  regret  to  Chile  to  appear  before 
this  with  a  poor  sanitary  equipment,  but  we  cherish  the  hope  that 
when  we  again  have  the  honor  of  welcoming  it,  our  situation  will  be 
very  different,  and  we  will  then  present  to  the  American  Republics  a 
new  example  of  what  can  be  accomplished  by  carrying  out  the  resolu- 
tions of  these  Conferences.  The  problem  that  should  now  be  solved 
among  us  is  far  from  presenting  the  difficulties  which  other  countries 
have  had  to  overcome,  and  which,  as  evidenced  by  the  reports  here 
read,  have  been  successfully  solved  in  practice. 

The  seat  of  the  Sixth  Sanitary  Conference,  the  capital  of  the 
Oriental  Republic  of  Uruguay,  the  progressive  city  of  Montevideo, 
and  the  high  merits  and  personal  qualifications  of  the  worthy  President 
of  that  Conference,  our  dear  and  respected  friend,  Dr.  Ernesto  Fer- 
nandez Espiro,  insure  the  greatest  success  of  that  meeting. 

We  wish  our  esteemed  colleagues  a  happy  return  trip,  and  we 
request  them  to  convey  to  their  respective  governments  the  expression 
of  our  esteem  and  our  appreciation  of  the  fact  that  they  selected 
representatives  who  have  deserved  our  most  cordial  and  respectful 
welcome.  I  do  not  believe  that  I  exaggerate  when  I  say  that,  on 
account  of  the  number  of  nations  herein  represented,  and  of  the 
importance  of  its  resolutions,  this  Conference  is  no  less  valuable  than 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  63 

the  preceding  one  and  that  it  marks  a  positive  progress  in  the  history 
of  these  periodical  meetings,  which  are  so  beneficial  to  the  sanitary 
betterment  and  to  the  moral  and  material  prosperity  of  the  American 
Republics. 

Dr  Cornejo,  at  his  request,  was  then  given  the  floor.  He  delivered 
a  short  speech  thanking  the  Delegates  for  their  attentions  to  him ; 
praising  the  work  of  the  Conference,  and  paying  a  high  compliment 
to  its  President,  Dr.  del  Rio. 


APPENDIX. 


Dr.    Alejandro   del   Rio,   of   Chile. 

President  of  the  Fifth   International   Sanitary   Conference  of  American 
Republics. 

Dr.  del  Rio,  unanimously  elected  by  the  Delegates  to  the  Fifth  Conference,  to 
preside  over  its  sessions,  is  one  of  the  most  prominent  hygienists  of  Chile, 
having  devoted  many  years  to  the  public  health  service  of  his  country. 
He  is  a  Professor  of  the  School  of  Medicine  of  the  University  of  Chile, 
member  of  the  Supreme  Council  of  Public  Health  and  administrator  of  the 
Public  Assistance.  By  his  genial  personality  and  exquisite  politeness,  the 
distinguished  President  won  the  affection  and  respect  of  all  the  Delegates, 
who  unanimously  gave  him  a  rising  vote  of  thanks.  One  of  the  most 
brilliant  functions  held  in  honor  of  the  Delegates  was  the  Garden  Party 
given  by  Dr.  del  Rio,  on  which  occasion  the  foreign  delegates  had  an 
opportunity  to  admire  the  beautiful  and  charming  ladies  of  the  beautiful 
capital   of  Chile. 


FIFTH  INTERNATIONAL  SANITARY  CONFERENCE  OF  THE 
AMERICAN  REPUBLICS. 


FESTIVITIES  AND  SOCIAL  FUNCTIONS  IN  HONOR  OF 
THE  DELEGATES. 

From  the  moment  the  foreign  Delegates  landed  on  the  hospitable  shores 
of  Chile,  they  were  accorded  a  most  cordial  welcome  and  attentions 
of  every  description  were  showered  upon  them  by  the  Chilean  Government  and 
people.  At  the  very  outset  they  were  surprised  and  delighted  by  the  arrange- 
ments made  in  advance  for  their  comfort  and  welfare.  No  expense  was 
spared  by  the  Government  to  meet  this  end  and  no  expense  was  permitted  the 
Delegates  from  their  own  purses,  if  it  came  within  the  legitimate  requirements 
of  the  work.  The  Delegates,  once  settled  in  their  quarters,  were  invited  by 
officials  and  individuals  to  innumerable  festivites. 

On  Saturday  afternoon,  November  4,  the  Delegates  presented  their  cre- 
dentials to  the  Under-Secretary  for  Foreign  Relations,  who  afterwards  intro- 
duced them  to  the  Ministers  for  Foreign  Relations  and  of  the  Interior.  An  hour 
later  they  were  received  by  the  President  of  the  Republic,  Dr.  Ramon  Barros 
Luco. 

At  the  conclusion  of  the  opening  session,  on  Sunday,  the  Delegates  drove  to 
the  course  of  the  Club  Hipico,  which  has  one  of  the  most  picturesque  race 
courses  on  the  American  Continent,  and  attended  the  races  as  specially  invited 
guests.  The  inaugural  day  concluded  with  a  magnificent  banquet  given  by  the 
Chilean  Delegation  to  the  visiting  Delegates  in  the  Club  Union.  At  this  dinner 
Senor  Paulino  Alfonso,  on  behalf  of  the  Chilean  Delegates,  welcomed  the  for- 
eign Delegates,  in  whose  name  Dr.  Fernando  Alvarez,  of  the  Argentine  Dele- 
gation, answered  in  equally  eloquent  terms.  After  the  banquet  each  Delegate 
was  given  a  beautiful  and  artistic  medal  as  an  emblem  of  the  Conference,  the 
work  of  the  famous  French  sculptor,  M.  Hippolyte  Lefebvre. 

On  Monday,  the  6th,  at  5  o'clock,  a  garden  party  was  given  by  the  President 
of  the  Conference,  Dr.  Alejandro  del  Rio,  at  Villa  Maria,  his  beautiful  country 
residence,  which  occasion  was  the  scene  of  the  reunion  of  all  the  members  of 
Santiago's  smartest  society  and  gave  the  Delegates  the  opportunity  of  meeting 
the  charming  and  beautiful  ladies  of  the  Chilean  capital. 

At  eight  o'clock  in  the  evening  of  Wednesday,  His  Excellency  the  President 
of  the  Republic  tendered  the  members  of  the  Conference  a  complimentary 
dinner,  which  was  held  in  the  State  dining  room  of  the  Palacio  de  la  Moneda, 
the  presidential  mansion,  which  was  also  attended  by  the  diplomatic  represen- 
tatives of  the  American  Republics,  the  members  of  the  cabinet  and  prominent 
officials   and   individuals. 

The  following  evening,  the  Argentine  Minister  gave  a  reception  and  dance, 
a  brilliant  affair,  which  was  much  enjoyed  by  the  Delegates  in  whose  honor 
it  was  given. 

On  Friday  evening,  the  Bolivian  Delegate.  Dr.  Claudio  Sanjines,  offered  to  his 
colleagues  a  splendid  banquet  at  the  Club  Union,  to  which  the  members  of  the 
Faculty  of  Medicine  of  Chile  were  also  invited.  At  the  conclusion  of  the 
dinner,  Dr.  Sanjines  drank  to  the  health  of  the  Delegates  after  a  brief  and 
eloquent  speech,  which  was  replied  by  Dr.  Vicente  Izquierdo,  the  Dean  of  the 
Faculty  of  Medicine.  Speeches  were  also  delivered  by  Dr.  Razetti,  of  Vene- 
zuela; Dr.  Vicencio.  of  Chile;  Dr.  Araoz  Alfaro.  of  the  Argentine  Republic; 
Dr.  Manterola,  of  Chile ;  Dr.  Guiteras,  of  the  United  States ;  Dr.  Carlos  Ibar, 
of  the  Chilean  Faculty  of  Medicine ;  and  Dr.  Alvarez,  of  the  Argentine  Republic. 

The  great  banquet  offered  by  the  Chilean  Government  in  honor  of  the  Dele- 
gates, to  celebrate  the  successful  closing  of  the  Conference,  took  place  on  Sat- 
urday, the  11th,  at  8  o'clock.  The  dinner  was  presided  over  by  the  Minister 
of  the  Interior,  Senor  Jose  Ramon  Gutierrez,  who  spoke  in  behalf  of  the 
Government.  Dr.  Guiteras,  of  the  United  States,  answered  in  the  name  of  the 
members  of  the  Conference.  Captain  Fortescue,  the  representative  of  the  Pan- 
American  Union,  also  delivered  a  speech. 


68  FIFTH    INTERNATIONAL   SANITARY   CONFERENCE. 

On  Sunday,  Senor  Francisco  Subercaseaux  extended  the  hospitality  of  his 
country  home,  La  Hacienda  del  Pirque ;  and  in  the  afternoon  the  Delegates 
attended  the  Corso  de  Flores,  or  flower  carnival,  given  in  their  honor  in  the 
Parque  Forestal. 

Having  been  invited  by  the  Intendent  and  the  Mayor  of  Valparaiso,  the  Dele- 
gates went  to  that  port  on  Monday,  the  13th,  to  visit  some  of  its  establish- 
ments and  institutions,  such  as  the  hospitals,  the  Pehuelas  water-works,  and 
Vina  del  Mar,  the  fashionable  summer  resort  of  Chile. 

When  not  in  session  the  time  of  the  delegates  was  occupied  in  visiting  the 
different  hospitals,  medical  schools,  model  sanitary  tenement  houses,  and  other 
institutions  of  this  nature  in  Santiago.  All  the  delegates  were  most  enthu- 
siastic in  their  praises  of  the  hygienic  institute,  an  institution  which  for  com- 
pleteness of  detail  and  general  perfection  can  not  be  surpassed.  The  visit  to 
the  school  of  medicine  and  clinical  hospital,  where  the  delegates  were  most 
hospitably  received  by  Dr.  Don  Vicente  Izquierdo,  the  distinguished  Dean  of 
the  Medical  Faculty,  was  a  most  instructive  one.  The  Delegates  everywhere  found 
much  to  hold  their  attention — at  the  sanitary  exposition  in  the  beautiful  "Palacio 
de  Bellas  Artes,"  the  Mixed  Hospital  of  Salvador,  the  Woman's  Hospital  of  San 
Francisco  de  Borja,  and  at  the  dental  school,  where  by  special  invitation  Dr. 
Gregorio  M.  Guiteras,  of  the  United  States  delegation,  made  an  address. 


RESOLUTIONS    PASSED    BY   THE   FIFTH    INTERNATIONAL    SANI- 
TARY CONFERENCE. 

The  Fifth  International  Sanitary  Conference  of  American  Republics,  having 
duly  considered  and  studied  all  the  subjects  provided  in  its  program,  has,  through 
the  intelligent  and  efficient  co-operation  of  the  Delegates  thereto,  passed  the 
following  Resolutions : 

Be  it  resolved : 

I.  1st,  that  the  appreciation  of  the  Conference  be  conveyed  to  the  Govern- 
ments represented;  2nd,  that  the  American  Governments  be  requested  to  send, 
whenever  possible,  delegates  who  are  trained  hygienists,  or  at  least,  who  are 
nationals  of  the  respective  country;  and  that  at  least  one  delegate  should  be  a 
high  sanitary  officer,  or  a  person  who  has  been  a  delegate  to  a  former 
conference. 

II.  That  each  Republic  should  transmit,  regularly,  to  the  International  Sani- 
tary Bureau  at  Washington,  and  to  the  Central  Committee  at  Montevideo,  all 
documents  and  reports  relating  to  sanitation  in  that  country.  These  documents 
should  include  demographic  conditions  in  the  chief  ports  and  cities  and  the 
data  relating  to  all  kinds  of  contagious  diseases. 

III.  That  it  be  recommended  that  the  International  Sanitary  Bureau  of 
Washington  shall  study  these  resolutions,  include  in  the  program  for  the  Sixth 
International  Sanitary  Conference  such  amendments  to  the  Washington  Con- 
vention as  it  may  deem  necessary,  and  submit  the  respective  proposed  amend- 
ments. 

IV.  That  it  be  recommended  that  each  Government  organize  substantial  and 
practical  courses  in  hygiene  and  sanitation,  so  that  specialists  might  be  de- 
veloped in  those  branches,  with  specific  diplomas  if  necessary,  qualified  to  carry 
out  in  future  the  work  of  sanitation. 

V.  That  it  be  recommended  to  the  nations  which  have  adhered  to  the  Sani- 
tary Convention  of  Washington,  that  they  formally  comply  with  its  provisions. 

VI.  That  it  be  recommended  that  causes  of  death  be  certified  to  by  physicians, 
at  least  in  cities  and  seaports,  in  order  to  secure  accuracy  in  statistics. 

VII.  That  the  establishment  be  recommended  of  fiscal  laboratories  for  the 
analysis  of  food  stuffs  and  drinks  imported  though  the  custom  houses. 

VIII.  That  nations  wherein  leprosy  exists  be  advised  to  keep  accurate  and 
detailed  statistics  of  lepers ;  to  organize  colonies  for  the  isolation  of  the  patients, 
and  to  enact  laws  to  ward  off  the  disease. 

IX.  That  it  be  recommended  to  the  Governments  of  the  American  Republics 
that  they  promote  or  facilitate  investigation  as  to  the  prevalence,  frequency  and 
contagiousness  of  scleroma. 

X.  That  it  be  recommended  that  prostitution  should  be  regulated  in  cities, 
and    specially    in    seaports,    intrusting    the    sanitary    inspection     to     physicians 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  69 

specially  prepared  on  the  subject,  discharging  their  duties  in  dispensaries  or 
polyclinics  provided  with  all  the  necessary  means;  and  that  persons  that  may 
transmit  infection  be  confined  in  hospitals  until  cured. 

XI.  That  it  be  recommended  that  the  Governments  establish  in  their  re- 
spective countries  a  "Permanent  Commission  on  Tuberculosis."  The  Pan- 
American  Union  of  Washington  shall,  through  the  diplomatic  representatives 
of  the  different  American  countries,  request  of  those  Governments  the  organi- 
zation of  said  Commission.  The  various  countries  should  also  exchange  infor- 
mation in  order  that  all  may  be  acquainted  with  the  methods  adopted  and  re- 
sults obtained. 

XII.  That  it  be  recommended  to  the  nations  adhering  to  the  Convention  of 
Washington  that  they  amend  their  rules  of  hygiene  at  ports  and  on  frontiers 
so  as  to  agree  with  the  terms  of  said  Convention. 

XIII.  That  it  be  recommended  that  upon  arrival  of  a  vessel,  a  bulletin  be 
posted  advising  the  passengers  on  board  as  to  the  sanitary  rules  to  which  they 
are  subject,  and  as  to  the  laws  or  regulations  by  virtue  of  which  such  rules 
are  enforced. 

XIV.  That  countries  taking  protective  measures  against  arrivals  from  other 
countries  be  recommended  to  maintain  on  board  such  vessels  sanitary  physicians 
possessing  the  necessary  technical  knowledge. 

XV.  That  it  be  recommended  that  vessels  conveying  passengers  or  immi- 
grants be  provided  with  apparatus  and  other  means  of  disinfection. 

XVI.  That  it  be  recommended  that  the  disinfection  of  ships  be  made  always 
in  the  presence  of  witnesses  in  order  to  insure  the  success  of  the  disinfection. 

XVIL  That  it  be  recommended  that  all  ships  conveying  passengers  be  pro- 
vided with  room  for  the  confinement  of  patients,  for  the  observation  of  persons 
suspected  of  infectious  diseases,  and  for  the  isolation  of  confirmed  cases. 

XVIII.  That  the  International  Sanitary  Information  Committees  of  the 
American  Republics,  besides  the  duties  intrusted  to  them  by  former  Confer- 
ences, shall  advise  their  respective  Governments  as  to  the  obligations  imposed 
by  the  International  Sanitary  Conferences  in  which  their  countries  have  par- 
ticipated, or  resulting  from  special  ratifications. 

XIX.  That  in  order  to  consider  a  person  as  immune  from  yellow  fever,  it  is 
necessary  that  be  shall  have  suffered  the  disease,  which  fact  must  be  proven 
by  a  certificate  from  the  sanitary  authorities  in  the  port  of  departure. 

XX.  That  it  be  recommended:  1st,  that  the  water  supply  and  sewer  system 
of  cities  be  constructed  and  operated  by  the  State  or  by  the  respective  munici- 
palities, without  regard  to  pecuniary  profit;  and,  2nd,  that  the  selection  of  a 
source  for  water  supply  should  be  made  by  hygienists  or  engineers,  by  common 
accord,  taking  into  consideration  the  condition  of  the  soil  and  possibility  of 
pollution. 

XXI.  That  each  Government  adhering  to  the  Sanitary  Conference,  in  carry- 
ing out  works  of  sanitation  and  hygiene,  give  special  attention  to  those  sea- 
ports and  cities  where  the  presence  of  endemic  and  infectious  diseases  shows 
clearly  that  the  health  of  the  world  will  be  improved  by  the  introduction  in  such 
places  of  modern  hygienic  and  sanitary  water  supply  and  drainage. 

XXII.  That  we  hereby  renew  the  recommendation  made  by  the  Third  Inter- 
national Sanitary  Conference  of  Mexico  of  1907,  to  the  effect  that  laws  be 
adopted   enforcing  vaccination   and  revaccination   against   small-pox. 

XXIII.  That  all  passengers  coming  from  cholera-infected  localities,  or  who 
may  incidentally  have  come  in  contact  with  cholera  patients,  shall  be  subjected 
to  bacteriological  examination  of  their  intestinal  excretions  and  shall  be  under 
sanitary  surveillance  if  it  be  confirmed  that  they  are  carriers  of  the  cholera 
bacillus ;  and  that  those  suffering  from  an  attack  of  cholera  shall  not  be  re- 
leased from  such  surveillance,  until  it  is  shown  that  the  bacillus  has  disappeared 
from  the  excretion. 

XXIV.  That  the  sanitary  report  that  each  delegation  must  submit  on  its 
respective  country  shall  be  delivered  in  due  time  to  the  secretary,  in  printed 
copies  to  be  distributed  in  the  preliminary  session. 

XXV.  That  we  recommend  the  Sixth  International  Sanitary  Conference  of 
Montevideo  to  study  epidemic  cerebrospinal  meningitis  and  transmissible  ante- 
rior polymilitis. 

XXVI.  That  reiteration  be  made  of  the  recommendations  passed  by  the 
previous  conferences  on  prophylactic  measures  against  plague,  specially  those 
regarding  the  destruction  of  rats,  both  on  land  and  on  board. 


REPORTS  SUBMITTED  BY  THE  COMMITTEES. 

REPORT  BY  THE  EXECUTIVE  COMMITTEE. 

Messrs.  Delegates  : 

Your  Executive  Committee,  after  studying  the  various  propositions  referred 
to  its  consideration,  recommends  that  the  following  be  adopted,  they  meeting, 
in  the  opinion  of  the  Committee,  the  general  requirements. 

(The   text   of   the   resolutions   appear   on    page  68.) 

Respectfully  submitted :  E.  Fernandez  Espiro,  Alejandro  del  Rio,  G.  M. 
Guiteras,  F.  Alvarez,  J.  E.  Monjaras,  Ismael  da  Rocha. 

The  I  Resolution  was  passed  in  view  of  a  motion  by  Dr.  G.  Amunategui,. 
of  Chile; 

The  II.  on  motions  by  Dr.  Guiteras.  of  the  United  States,  Drs.  Fernandez 
Espiro  and  Oliver,  of  Uruguay,  and  Dr.  Del   Rio,  of  Chile; 

The  III,  on  motions  by  Dr.  Roberts,  of  Cuba,  Dr.  Davila  Boza,  of  Chile, 
Dr.  Guiteras,  of  the  United  States,  and  Dr.  Razetti,  of  Venezuela; 

The  IV,  on  a  motion  by  Drs.  Araoz  Alfaro  and  Alvarez  of  the  Argentine 
Republic ; 

The  V,  on  motion  by  Dr.  Cornejo  y  Gomez,  of  Ecuador,  and  Dr.  Mon- 
jaras, of  Mexico; 

The  VI,  on  motion  by  Dr.  del  Rio,  of  Chile; 

The  VII,  on  motion  by  Dr.  Asta-Buruaga,  of  Chile; 

The  VIII,  on  motion  by  Dr.  Urizar,  of  Paraguay; 

The  IX  and  X  on  motion  by  Dr.  del  Rio,  of  Chile; 

The  XI,  on  a  motion  by  Dr.  Soza,  of  Chile; 

The  XII,  XIII,  XIV,  XV,  XVI,  and  XVII,  on  motions  by  Dr.  Monjaras,  of 
^Lexico ; 

The  XVIII,  on  motion  by  Dr.  Ferrer,  of  Chile; 

The  XIX,  in  view  of  the  report  by  the  Committee  on  Yellow  Fever; 

The  XX,  on  a  motion  by  Dr.  Illataes,  of  Chile; 

The  XXI,  on  a  motion  by  Dr.  Vial,  of  Chile; 

The  XXII,  on  a  motion  by  Dr.  Sanjines,  of  Bolivia; 

The  XXIII  is  based  on  the  report  of  the  Committee  on  Cholera; 

The  XXIV,  on  a  motion  by  Dr.  Vicencio,  of  Colombia; 

The  XXV,  on  a  motion  by  the  Argentine  Delegates ; 

The  XXVI,  is  based  on  the  report  of  the  Committee  of  Plague  and  on  a 
motion  by  Dr.  Cornejo  y  Gomez,  of  Ecuador. 

The  Executive  Committee  also  took  under  consideration  the  following  mo- 
tions, which  were  submitted  to  the  Conference: 

A  motion  by  the  Venezuelan  Delegation  proposing  that  it  be  recommended 
that  the  Governments  of  America  adopt  the  modifications  to  the  abbreviated 
Nomenclature  of  Bertillon's  Classification,  introduced  by  the  Bureau  of  Sta- 
tistics of  the  Venezuelan  Department  of  Promotion. 

A  motion  by  Dr.  Ferrer,  of  Chile,  recommending  the  insertion  of  the  reso- 
lutions passed  by  the  four  previous  Conferences  in  the  Transactions  of  the 
Fifth,  and  that  the  Pan  American  Union  be  requested  to  call  the  attention  to 
the  necessity  of  complying  with  the  sanitary  agreements  adopted. 

A  motion  by  Dr.  J.  E.  Monjaras,  of  Mexico,  regarding  the  diagnosis  of 
yellow   fever. 

A  motion  by  Dr.  Vicencio,  of  Colombia,  recommending  the  establishment 
of  pediatria   services 

A  motion  by  Dr.  Lauda,  of  Chile,  recommending  the  adoption  of  immigra- 
tion laws  in  accordance  with  modern  sanitation. 

A  motion  by  Dr.  Manterola,  of  Chile,  recommending  the  construction  of 
school  houses  according  to  the  rules  of  school  hygiene,  and  so  built  that  they 
shall  be  a  guarantee  to  the  life  of  the  pupils. 

A  motion  by  Dr.  del  Rio,  of  Chile,  recommending  the  publication  in  Spanish 
of  a  text  and  atlas  of  school  and  administrative  hygiene  for  use  by  officers 
having  charge  of  public  hygiene. 


72  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

REPORT   BY   THE   COMMITTEE   ON   CREDENTIALS. 

Your  Committee  on  Credentials  has  examined  the  Powers  exhibited  by  the 
following  delegates : 

Argentine  Republic. — Doctores  Don  Gregorio  Araoz  Alfaro  y  Don  Fernando 
Alvarez. 

Bolivia. — Doctor  Don  Claudio  Sanjines. 

Brasil. — General  Doctor  Don  Ismael  da  Rocha  y  Doctor  Don  Antonio 
Ferrari. 

Colombia. — Doctor  Don  Alcibiades  Vicencio. 

Costa  Rica. — Doctor   Don  Fernando  Iglesias. 

Cuba. — Doctor  Don  Hugo  Roberts. 

Dominican  Republic. — Doctor  Don  Jose  R.  Campos  y  Senor  Don  Tito 
Lizoni. 

Ecuador. — Doctor  Don  Luis  F.  Cornejo  y  Gomez. 

Guatemala. — Doctor  Don  Salvador  Ortega  y  Don  Julio  Bianchi. 

Mexico. — Doctor  Don  Jesus  Monjaras. 

Panama. — Doctor  Don  Caupolican  Pardo  Correa. 

Paraguay. — Doctor  Don  Rogelio  Urizar. 

Salvador. — Doctor  Don  Juan  B.  Miranda. 

United  States. — Doctors  Gregorio  M.  Guiteras  y  J.  C.  Perry,  of  the  U.  S. 
Public  Health  and  Marine  Hospital  Service. 

Uruguay. — Doctores  Don  Ernesto  Fernandez  Espiro  y  Don  Jaime  H.  Oliver. 

Venezuela. — Doctores  Don  Pablo  Acosta  Ortiz  y  Don  Luis  Razetti. 

Pan  American  Union. — Capitan  Granville  R.  Fortescue. 

And  having  found  the  said  Credentials  in  due  form,  it  recommends  that  they 
be  approved. 

Santiago,  November  8,  1911. — Vicente  Izquierdo. — Kaupolican  Pardo  Correa. 
— R.  Corbalan  Melgarejo. — Paulino  Alfonso. 

REPORT  BY  THE  COMMITTEE  ON  BUBONIC  PLAGUE. 

Your  Committee  has  studied  the  four  motions  submitted  respectively  by 
Dr.  C.  Sanjines,  of  Bolivia;  Dr.  H.  Roberts,  of  Cuba;  Dr.  R.  Davila  Boza,  of 
Chile;  and  Dr.  R.  Urizar,  of  Paraguay,  and  has  the  honor  to  recommend  that 
action  as  follows  be  taken  on  each  of  the  said  motions : 

MOTION    OF   THE   BOLIVIAN   DELEGATE. 

As  all  proposed  resolutions  should  be  equally  applicable  to  all  the  nations 
of  the  Continent  and  not  limited  to  any  given  country  or  countries,  this  motion 
is  amended  as  follows : 

Resolved,  That  reiteration  be  made  to  the  Governments  as  to  the  necessity 
of  improving  the  sanitary  conditions  of  ports  in  pursuance  of  the  Washington 
Sanitary  Convention,  and  to  signify  to  them  the  desire  of  the  Fifth  Sanitary 
Conference  that  there  should  be  undertaken  as  soon  as  possible  the  establish- 
ment of  experimental  bacteriological  laboratories,  the  destruction  of  rats,  the 
increase  and  improvement  of  sanitary  stations  in  the  principal  ports,  and  other 
prophylactic  measures  recommended. 

MOTION    BY   THE   CUBAN    DELEGATE. 

The  Committee  recommends  that  the  motion  submitted  by  Dr.  Roberts  be 
approved  in  all  its  parts  as  follows : 

1st.  Every  vessel  engaged  in  navigation  should  be  provided,  besides  other 
sanitary  papers,  with  a  certificate  from  a  competent  authority,  to  the  effect 
that  the  vessel  has  been  totally  freed  from  rats,  within  a  period  not  over  six 
months. 

2nd.  This  document  shall  be  deemed  indispensable,  like  other  health  docu- 
ments required  by  maritime  sanitary  authorities,  and  no  ship  that  is  not  pro- 
vided with  the  said  certificate  shall  be  allowed  to  engage  in  navigation. 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  73 

3rd.     The   nations   participating   in   this    conference   shall   allow   a   period   of 

not  more  than  six  months  within  which  their  respective  ships  shall  comply  with 

this  provision. 
Your  Committee  further  suggests  the  addition  of  the   following  paragraph: 
4th.     Said   certificates    shall    be   valid   only    for   non-infected    ships ;    infected 

ships  shall  be  subject  to  disinfection  and  destruction  of  rats,  as  may  be  ordered 

by  the  sanitary  authorities  of  the  port. 

MOTION   BY  THE   CHTLEAN    DELEGATE,   DR.   DAVILA   BOZA. 

Your  Committee  suggests  that  this  motion  be  modified  so  that  it  shall  be 
in  the  nature  of  a  recommendation  and  not  an  amendment  to  the  Washington 
Convention.     With  said  modification  the  motion  would  read  as  follows : 

That  it  be  recommended  that  the  maritime  sanitary  authorities  endeavor  to 
carry  out  the  destruction  of  rats  in  ships  before  unloading,  and  if  not  pos- 
sible, within  48  hours  after;  without  damaging  the  merchandise,  the  vessel  or 
its  engines. 

MOTION   BY   DR.    URIZAR,   OF   PARAGUAY. 

Your  Committee  suggests  that  this  motion  be  approved,  not  as  a  resolu- 
tion, but  merely  as  a  recommendation,  considering  that  the  aseptic  serum 
from  horses  is  not  of  a  lasting  effect. 

Santiago,  November  10,  1911. — Dr.  Antonio  Ferrari. — L.  F.  Cornejo  Gomez. 
— P.  L.  Ferrer. 

REPORT  BY  THE  COMMITTEE  ON  MALARIA. 

Your  Committee  on  Malaria  has  the  honor  to  report  as  follows  on  the 
motion  submitted  by  the  Venezuelan  Delegation : 

That  it  be  recommended  to  the  Governments  in  whose  countries  the  malarial 
epidemic  prevails,  that  they  adopt,  as  the  fundamental  code  for  the  anti- 
malaria  campaign,  the  resolutions  and  recommendations  passed  by  the  Simla 
Conference,  as  proposed  by  the  said  delegation,  or  any  other  regulations  the 
effectiveness  of  which  has  been  shown  in  other  countries  and  which  may  be 
specially  applicable  to  the  American  Republic.  And  that  the  Delegates  shall 
report  upon  the  results  obtained  in  the  anti-malaria  campaign  in  their  re- 
spective countries. 

Santiago,    November  9,    1911. — J.    C.   Perry.— Claudio   Sanjines. — H.    Roberts. 

REPORT  OF  THE  COMMITTEE  ON  YELLOW  FEVER. 

The  Committee  on  Yellow  Fever  has  the  honor  to  report  on  the  motions 
presented  by  the  delegates  indicated,  as  follows : 

With  regard  to  yellow  fever  two  different  opinions  have  been  submitted 
as  to  what  constitutes  immunity  from  said  disease  for  practical  quarantine 
purposes. 

According  to  the  United  States  Delegation,  only  those  producing  a  cer- 
tificate to  the  effect  that  they  have  previously  suffered  from  the  disease. 

According  to  the  Cuban  Delegation,  persons  immune  from  the  disease  are, 
not  only  those  who  have  suffered  from  the  disease,  but  also  those  who  have 
lived  for  over  ten  consecutive  years  in  an  endemic  focus  of  yellow  fever 
without  having  contracted  the  disease. 

Santiago,    November  9.    1911. — J.   C.    Perry. — Claudio   Sanjines. — H.    Roberts. 

REPORT  OF  THE  COMMITTEE  ON  CHOLERA. 

Your  Committee  on  Cholera  has  studied  the  four  motives  submitted  by  Dr. 
Roberts,  of  Cuba,  Drs.  Araoz  Alfaro  and  Alvarez,  of  the  Argentine  Republic, 
and  Dr.  Guiteras,  of  the  United  States,  all  of  which  agree  in  principles ;  there- 
fore, your  Committee  recommends  that  the  following  be  adopted,  which  har- 
monizes with  the  fundamental  ideas :  "Be  it  resolved  that  all  passengers 
coming  from  cholera-infected  localities,  or  who  may  incidentally  have  come  in 
contact    with   cholera    patients,    shall    be   subjected   to   bacteriological   examina- 


74  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

tions  of  their  intestinal  excretions  and  shall  be  under  sanitary  surveillance 
if  it  be  confirmed  that  they  are  carriers  of  the  cholera  bacillus;  and  that  those 
suffering  from  an  attack  of  cholera  shall  not  be  released  from  such  surveil- 
lance, until  it  is  shown  that  the  bacillus  has  disappeared  from  the  excretion. 
Santiago,  November  9,  1911. — Luis  Asta  Buruaga. — G.  Araoz  Alfaro. 

REPORTS  BY  THE  COMMITTEE  ON  SANITATION  OF  COAST  AND 

FRONTIER   TOWNS. 

I.  Your  Committee  on  Sanitation  of  Coast  and  Frontier  Towns,  having 
studied  the  motion  by  the  Chilean  Delegate  Sr.  Illanes,  recommends  its  adop- 
tion, with  this  amendment :  add  after  the  word  "respective"  the  following : 
"by  administration  or  by  contract. — J.  H.  Oliver. — Carlos  Altamirano — E. 
Garcia  Collao. — Manuel  C.  Vial. 

MOTION    BY    ENGINEER    ILLANES,    OF    CHILE. 

Be  it  recommended  that  the  water  supply  and  sewer  system  of  cities  be 
constructed  and  operated  by  the  State  or  by  the  respective  municipalities, 
without  regard  to  pecuniary  profit;  and,  2nd,  that  the  selection  of  a  source 
for  water  supply  should  be  made  by  hygienists  or  engineers,  by  common  ac- 
cord, taking  into  consideration  the  condition  of  the  soil  and  the  possibility 
of  pollution. 

II.  Your  Committee  on  Sanitation  of  Coast  and  Frontier  Towns,  having 
studied  the  motion  by  Dr.  Manuel  Camilo  Vial,  of  Chile,  recommends  its 
adoption. — Guillermo  Illanes. — J.  H.  Oliver. — Carlos  Altamirano. — E.  Garcia 
Collao. 

MOTION    BY    DR.    MANUEL   C.    VIAL,   OF    CHILE. 

That  each  Government  adhering  to  the  Sanitary  Conference,  in  carrying  out 
works  of  sanitation  and  hygiene,  give  special  attention  to  those  seaports  and 
cities  where  the  presence  of  endemic  and  infectious  diseases  shows  clearly 
that  the  health  of  the  world  will  be  improved  by  the  introduction  in  such 
places  of  modern  hygienic  and  sanitary  water  supply  and  drainage. 

REPORTS  BY  THE  COMMITTEE  ON  PROPHYLAXIS  OF  ACUTE 
TRANSMISSIBLE   DISEASES. 

I.  Your  Committee  on  Prophylaxis  on  Acute  Transmissible  Diseases  has  the 
honor  to  report  upon  the  motion  by  Dr.  Claudio  Sanjines,  of  Bolivia,  which 
is  as  follows : 

"Be  it  resolved  that  we  hereby  renew  the  recommendation  made  by  the 
Third  International  Sanitary  Conference  of  Mexico  of  1907,  to  the  effect  that 
laws  be  adopted  enforcing  vaccination  and  revaccination  against  small- pox. 

And  we  have  the  honor  to  recommend  that  it  be  adopted  in  full. — Alci- 
biades    Vicencio. — Juan   B.    Miranda. — P.   Acosta   Ortiz. — Fernando    Iglesias. 

Your  Committee  on  Prophylaxis  on  Acute  Transmissible  Diseases  has  the 
honor  to  report  upon  the  motion  submitted  by  the  Argentine  Delegates  recom- 
mending that  vaccination  be  taught  practically  in  normal  schools. 

Although  the  idea  of  the  Argentine  Delegates  is  worthy  of  applause,  this 
Committee  does  not  deem  it  wise  to  recommend  its  adoption.  It  is  a  good 
idea  in  particular  cases,  but  it  is  not  of  general  interest.  On  the  other  hand, 
since  vaccination  is  compulsory  in  most  countries,  the  proposition  might  be 
included  in  the  laws  or  regulations  of  the  respective  nation,  which  legislation 
must  vary  according  to  the  topography,  nature  of  the  population,  etc. — P. 
Acosta  Ortiz. — Alcibiades  Vicencio. — Juan  B.  Miranda. — Fernando  Iglesias. 

REPORT   BY    THE   COMMITTEE   ON    PROPHYLAXIS    OF   CHRONIC 
TRANSMISSIBLE  DISEASES. 

Your  Committee  on  Prophylaxis  of  Chronic  Transmissible  Diseases  has 
studied  the  following  motions  : 


FIFTH    INTERNATIONAL  SANITARY  CONFERENCE.  75 

(1)     MOTION    BY    DR.    URIZAR,    OF    PARAGUAY. 

Whereas  leprosy  is  spreading  in  America  and  invading  new  regions,  be  it 
resolved  that  nations  wherein  leprosy  exists  be  advised  to  keep  accurate  and 
detailed  statistics  of  lepers ;  to  organize  colonies  for  the  isolation  of  the 
patients,  and  to  enact  laws  to  ward  off  the  disease. 

(2)    MOTION    BY   DR.   DEL  RIO,  OF   CHILE. 

"Resolved  that  it  be  recommended  to  the  Governments  of  the  American 
Republics  that  they  promote  or  facilitate  investigation  as  to  the  prevalence, 
frequency  and  contagiousness  of  scleroma. 

(3)    MOTION   BY  THE    SAME. 

That  it  be  recommended  that  prostitution  should  be  regulated  in  cities,  and 
specially  in  seaports,  intrusting  the  sanitary  inspection  to  physicians  specially 
prepared  on  the  subject,  discharging  their  duties  in  dispensaries  or  polyclinics 
provided  with  all  the  necessary  means ;  and  that  persons  that  may  transmit 
infection  be  confined  in  hospitals  until  cured. 

(4)    MOTION   BY   DR.    S0ZA,  OF  CHILE. 

That  it  be  recommended  that  the  Governments  establish  in  their  respective 
countries  a  "Permanent  Commission  on  Tuberculosis."  The  Pan  American 
Union  of  Washington  shall,  through  the  diplomatic  representatives  of  the  dif- 
ferent American  countries,  request  of  those  Governments  the  organization  of 
said  Commission.  The  various  countries  should  also  exchange  information  in 
order  that  all  may  be  acquainted  with  the  methods  adopted  and  results  ob- 
tained." 

We  have  the  honor  to  recommend  the  adoption  of  the  above  motions,  with- 
out any  amendments. — Santiago,  November  9,  1911. — Roberto  del  Rio. — R. 
Urizar. — Salvador  Ortega. — Ernesto   Soza. 


REPORT  OF  THE  ARGENTINE  DELEGATION,  CONSIST- 
ING OF  DOCTORS  GREGORIO  ARAOZ  ALFARO  AND 
FERNANDO  ALVAREZ. 

I. 

SANITARY    POLICE    LEGISLATION    AND    SANITARY    MEASURES    ADOPTED    SINCE    THE   4tH 

CONFERENCE. 

As  our  country  has  not  attended  the  preceding  conferences,  we  deem  it  neces- 
sary to  submit  a  general  sketch  of  our  sanitary  organization. 

Ours  being  a  federal  system  of  government,  our  National  Government  does  not 
exercise  any  direct  jurisdiction  on  sanitation,  except  in  the  capital  and  federal 
territories,  and  on  matters  relating  to  ports  and  land  frontiers. 

The  superior  sanitary  authority  is  called  "National  Department  of  Hygiene" 
and  is  constituted  by  an  "Advisory  Board,"  consisting  of  3  physicians  who  are 
experts  on  hygiene,  1  veterinary  surgeon,  1  member  of  the  Army  Sanitary  Serv- 
ice, and  1  president  who  has  executive  powers.  This  Department  is  under  the 
Ministry  of  the  Interior  and  consists  of  the  following  sections: 

Marine  Sanitation,  the  service  extending  to  all  the  ports  of  the  republic. 

Interior  Sanitation,  embracing  the  following  sections :  Vaccination,  Malaria, 
Social  and  Industrial  Hygiene,  Railways,  Demography,  Inspection  of  Pharmacies, 
and 

School  Hygiene. 

Under  this  Department  the  following  sections  are  placed : 

Chemical  Laboratory,  for  analysis  of  foods,  medicines,  specific,  etc.; 

Bacteriological  Laboratory,  destined  to  the  preparation  of  serum,  aside  from 
hygienic  examinations  and  investigations.  A  beautiful  ample  building  is  being 
erected  outside  of  the  city  limits,  for  this  Laboratory. 

Division  of  disinfection,  embracing  all  sorts  of  disinfections  by  means  of 
formol  and  other  chemical  preparations,  Clayton  and  Marot  apparatuses  for  the 
destruction  of  rats,  etc. 

The  annual  budget  for  the  Department  of  Hygiene  amounts  at  the  present 
time  to  about  $1,400,000  gold,  besides  a  sum  of  about  $100,000  gold,  destined  by 
law  for  the  antimalarial  campaign.  The  Government  has  requested  for  the  next 
fiscal  year  an  additional  $800,000  for  the  termination  of  the  sanitary  stations  in 
the  principal  provincial  cities. 

In  the  city  of  Buenos  Ayres,  having  a  population  of  about  1,200,000  inhabitants, 
the  local  service  is  in  the  hands  of  the  "Direction  General  of  Public  Beneficence 
and  Sanitary  Administration"  under  the  Municipality.  This  Direction  General 
controls  all  hospitals,  asylums,  and  certain  dispensaries,  service  of  first  aid; 
dispensaries,  etc.,  for  children;  inspection  of  prostitution,  inspection  of  slaughter 
houses,  markets,  and  foods;  vaccine,  bacteriological  laboratory,  disinfection, 
with  several  stations  within  the  city,  and  special  gangs  for  the  killing  of  rats, 
etc.  This  service  is  completed  by  those  under  the  foundling  and  orphan  asylum 
and  the  Benevolent  Society. 

There  is  in  each  province  a  Board  of  Hygiene,  whose  functions  and  organi- 
zation are  similar  to  those  of  the  National  Department  and  Public  Beneficence 
established  in  all  the  important  towns. 


Our  sanitary  legislation  consists  of  the  following: 

An  act  creating  the  National  Department  of  Hygiene,  amended  last  year,  as  to 
organization. 

Municipal  and  Provincial  Orders,  organizing  the  Division  of  Public  Charities, 
Boards  of  Hygiene,  Disinfection,  etc. 

Regulations  of  the  Land  and  Marine  Sanitary  police. 

Law  providing  for  compulsory  vaccination  and  revaccination  in  the  capital  and 
federal  territories.    Several  of  the  provinces  have  also  enacted  similar  legislation. 

Legislation  against  malaria. 

The  provinces  and  municipalities  have  also  enacted  special  legislation,  regu- 
lating the  inspection  of  food,  medicines,  buildings,  prostitution,  etc.  The  Sani- 
tary Direction  of  the  Province  of  Buenos  Ayres  deserves  all  commendation  be- 
cause of  its  completeness. 


78  FIFTH    INTERNATIONAL   SANITARY   CONFERENCE. 

The  General  Direction  of  Sanitary  Works,  dependent  from  the  Ministry  of 
Public  Works  is  in  charge  of  the  construction  and  operation  of  the  system  of 
potable  waters  and  sewerage  in  the  capital  city  and  in  such  provinces  as  request 
the  aid  of  the  National  Government. 

II. 

RESOLUTIONS    ADOPTED    BY    THE    FOUR   PRECEDING    CONFERENCES. 

Notwithstanding  the  fact  that  our  country  did  not  attend  the  four  preceding 
conferences,  almost  all  the  recommendations  adopted  by  them  had  already  been 
enforced  by  us,  even  before  such  recommendations,  as  will  be  shown  in  the  body 
of  this  report.  On  the  other  hand,  the  Sanitary  Convention  of  Argentine, 
Uruguay,  Paraguay  and  Brazil,  signed  at  Rio  de  Janeiro  in  1904  and  still  in 
force,  is  based  on  the  same  principles  as  that  of  Washington  in  1905. 

Ill  AND  IV. 

Not  having  attended  the  preceding  conferences  we  cannot  report  on  these 
points,  but  we  have  no  doubt  that  our  government  will  lose  no  time  in  com- 
municating with  the  Montevideo  and  Washington  Bureaus. 

V. 

SANITATION    OF    CITIES    AND    ESPECIALLY    OF    PORTS,    STATING    WHAT    THE    NATIONAL 
GOVERNMENT    HAS   DONE   IN   THIS    MATTER. 

Buenos  Ayres,  La  Plata,  Rosario,  and  Bahia  Blanca,  the  principal  ports  of  our 
country,  have  enjoyed  for  a  number  of  years  a  complete  sanitary  service,  such 
as  an  abundance  of  excellent  potable  water,  sewerage  and  drainage  systems,  in- 
spection,   disinfection  and  deratization  systems,  etc. 

Other  ports  of  lesser  importance  in  the  south,  as  well  as  the  river  ports  are 
all  being  furnished  with  such  systems  by  the  National  Government. 

There  has  never  been  any  endemic  disease  in  any  of  our  ports.  As  regards 
the  provincial  towns,  important  works  of  sanitation  have  been  undertaken  with 
the  aid  of  the  National  Government,  and  in  the  poorer  provinces  by  the  Federal 
Government  alone.  In  all  the  capital  cities,  there  are  at  present  good  systems 
of  pure,  excellent  drinking  water  and  this  work  is  being  extended  to  smaller 
towns  in  the  province  of  Buenos  Ayres  in  the  campaign  against  typhoid  fever, 
due  frequently  to  well  water.  Cordoba  is  now  furnishing  an  extensive  sewer 
system,  and  Tucuman,  Salta,  Catamarca  and  Jujuy,  towns  where  malaria  was 
prevalent,  have  almost  completed  their  sanitary  work  under  the  Direction  Gen- 
eral of  Sanitary  Works  of  the  Capital,  and  malaria  has  already  decreased  to  a 
remarkable  extent. 

We  have  the  satisfaction  of  stating  that  a  few  years  hence  not  one  city  will  be 
found  in  the  republic  without  a  complete  sanitary  service.  In  all  the  provinces 
and  federal  territories  there  are  in  operation  disinfection  stations,  with  a  special 
personnel  devoted  to  the  work  of  deratization,  this  service  being  maintained  by 
provincial  appropriations  in  the  richer  states  and  by  the  federal  government  in 
the  poorer  states. 

VI. 

PROPHYLACTIC  MEASURES  ADOPTED  AGAINST  PLAGUE,  CHOLERA  AND  YELLOW  FEVER, 
WITH  SPECIFICATION  OF  THE  MEANS  EMPLOYED  IN  THE  DESTRUCTION  OF  RATS, 
FLIES    AND    MOSQUITOES. 

Plague.  Of  all  these  diseases  only  the  plague,  which  was  introduced  in  1900, 
sporadically  appears  in  some  places  in  the  republic,  and  once  in  a  while  a  small 
focus  consisting  of  8  or  10  cases  is  found.  These  cases  have  in  reality  no  col- 
lective importance,  but  serve  to  demonstrate  the  enormous  difficulty  of  com- 
pletely stamping  out  the  disease,  particularly  in  our  country  because  of  the  im- 
mense quantity  of  cereals  and  grains  to  be  harvested,  stored  and  exported  every 
year. 


FIFTH    INTERNATIONAL   SANITARY   CONFERENCE.  79 

The  principal  means  adopted  to  fight  the  plague  are : 

Systematic  deratization  of  all  ships  coming  to  port.  In  the  port  of  Buenos 
Ayres  there  are  Clayton  apparatuses  on  wagons,  while  in  other  ports  both  the 
Clayton  and  Marot  systems  are  used.  Besides  these  methods  there  are  special 
devices  used  to  prevent  the  landing  of  rats,  over  ropes,  chains,  etc.  Gangs  of 
men  are  permanently  engaged  in  the  cities  and  in  the  water  front  in  the  destruc- 
tion of  rats  by  means  of  portable  "Gubba"  generators  of  gases.  Neither  the 
serum  nor  the  fluids  from  Europe  have  been  successful.  A  certain  number  of 
dead  rats  is  sent  from  each  batch  for  dissection  and  bacteriological  examination. 
Should  any  appear  to  be  infected  the  houses  are  surrounded  and  the  extermina- 
tion made  as  thorough  as  possible. 

There  is  an  ordinance  in  force  in  Buenos  Ayres  providing  for  the  rat  proof 
construction  of  all  new  buildings.  Railway  stations,  stables,  granaries,  mills 
and  grain  warehouses  are  subject  to  special  vigilance  for  the  extermination  of 
rats.  So  far  as  garbage  is  concerned  for  many  years  it  has  been  kept  and  col- 
lected by  most  approved  methods.  Large  Backer  ovens  will  soon  be  built  for 
the  cremation  of  garbage,  thus  doing  away  with  the  obsolete  system  of  burning. 

Cholera.  For  many  years  we  have  not  had  a  case  of  cholera  in  the  cities. 
One  or  two  cases  arriving  in  ships  from  abroad  have  been  isolated  and  treated  in 
the  Island  of  Martin  Garcia.  In  the  matter  of  prophylaxis  against  cholera,  in 
the  last  few  years,  especially  because  of  the  epidemics  of  Italy,  and  the  cases  in 
Trieste  and  Marseilles,  the  country  has  been  governed  by  the  Sanitary  Conven- 
tion of  Rio  de  Janeiro,  which  we  have  already  mentioned  as  based  upon  the  most 
liberal  principles.  We  desire  to  call  special  attention  to  the  fact  that  our 
Department  of  Hygiene  has  given  for  the  last  year  considerable  importance  to 
the  investigations  of  the  bacillus  carriers,  and  that  we  have  been  lately  able  to 
find  in  healthy  passengers  from  Italian  ports  the  cholera  bacillus.  We  believe 
that  it  is  necessary  to  further  extend  the  prophylactic  measures  in  this  respect, 
and  we  will  later  have  the  honor  to  submit  a  resolution  covering  this  point. 

Yellow  fever.  It  does  not  exist  in  our  country  and  fortunately  during  the  last 
few  years  very  few  cases  have  arrived  at  our  ports  from  Brazil.  The  provisions 
of  the  Convention  of  Rio  de  Janeiro  are  enforced  in  these  Cases. 

VII. 

As  there  is  no  yellow  fever  in  our  country,  we  cannot  express  an  opinion  on 
this  topic. 

VIII. 

NATIONAL  AND  INTERNATIONAL  PROPHYLAXIS  IN  TUBERCULOSIS,  VENEREAL  DISEASES, 
SMALLPOX,  MALARIA,  TRACHOMA,  LEPROSY,  AND  SCLEROMA.  LEGISLATION  ON 
THE    SUBJECT   AND  RESULTS    OBTAINED. 

Tuberculosis  has  been  for  many  years  the  object  of  an  unrelenting  and  unin- 
terrupted campaign  by  the  authorities  and  by  the  Argentine  League  against 
Tuberculosis,  in  connection  with  the  International  League.  We  have  regulations 
and  ordinances  prohibiting  expectorating  outside  of  cuspidores,  receiving  pa- 
tients declared  as  suffering  from  tuberculosis  in  common  hospitals,  and  pre- 
scribing periodical  disinfection  of  railways,  tramways,  etc.,  and  the  houses  of 
those  suffering  from  tuberculosis  or  who  have  died  from  the  disease.  There 
are  special  dispensaries  and  sanitariums,  both  in  Buenos  Ayres  and  Cordoba, 
open  air  schools,  special  colonies,  etc. 

Against  venereal  diseases.  There  are  in  the  capital  and  in  all  provinces  regu- 
lations relative  to  venereal  diseases,  such  as  those  regulating  prostitution,  peri- 
odical examination  of  prostitutes,  identification  cards,  etc.  There  are  also  free 
consultation  rooms  for  those  having  secret  diseases  and  a  Social  Hygiene  Al- 
liance has  lately  been  established  for  prophylactic  purposes. 

For  smallpox  there  is  compulsory  vaccination  and  revaccination,  with  animal 
virus  from  an  excellent  and  old  National  institute.  During  the  past  and  in  the 
present  year,  there  has  been  in  certain  portions  of  the  country,  Tucuman  and 
Mendoza  principally,  a  slight  epidemic  of  smallpox  which  has  permitted  the  em- 
ployment of  the  method  of  intensive  revaccination.  The  epidemic  has  almost 
disappeared.     Immigrants  are  not  allowed  to  enter  the  country  unless  vaccinated. 

Malarial  or  paludic  fever  has  been  a  source  of  preoccupation  for  all  in  our 


80  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

country  because  of  our  territorial  extent  (3,000,000  square  kilometers),  contain- 
ing all  sorts  of  climate.  We  have  a  vast  malarial  region  of  over  400,000  square 
kilometers,  mainly  in  the  provinces  of  Tucuman,  Salta,  Jujuy,  Catamarca  and 
the  Territory  of  Chaco,  and  portions  of  Santiago  and  Cordoba.  We  have  a  law 
against  malaria,  and  we  are  now  carrying  on  a  most  active  campaign  against 
malaria,  employing  all  known  means,  such  as  quinine  as  a  cure  and  as  a  pre- 
ventive, protection  against  mosquitoes,  extermination  of  mosquitoes  by  means  of 
fumigation,  petroleum,  reclamation  of  swampy  lands,  and  other  means.  In  cer- 
tain regions  where  it  was  necessary  to  have  still  water,  as  lakes  or  reservoirs, 
for  the  use  of  men  and  beast,  flowing  wells  are  being  built,  so  as  to  do  away  with 
the  old  system.  For  this  campaign  against  malaria  the  budget  in  force  carries 
an  appropriation  of  about  $100,000,  gold,  but  there  is  a  movement  on  foot  to 
increase  this  sum  to  about  $1,000,000,  gold. 

Trachoma  is  a  rare  disease  among  us  and  not  endemic.  No  person  suffering 
from  trachoma  is  allowed  to  enter  the  country. 

Leprosy  is  scarce  in  Argentina.  Some  years  ago  there  was  a  great  deal  of  in- 
terest shown  in  this  disease,  resulting  in  a  Congress  of  Leprosy  being  held  in 
Buenos  Ayres,  when  a  complete  census  of  lepers  was  made.  In  the  entire  re- 
public, having  a  population  of  about  7,000,000  the  number  of  lepers  does  not  ex- 
ceed 300  odd  cases,  and  allowing  an  ample  margin  for  omissions  we  may  say 
they  do  not  reach  500.  The  lepers  are  to  be  isolated  either  in  a  special  hospital  in 
Buenos  Ayres  or  in  a  leper  colony  on  an  island  in  the  province  of  Entre  Rios, 
where  there  are  a  few  cases  as  in  Corrientes  and  Santa  Fe. 

Scleroma  is  unknown  in  Argentina. 

IX. 

MONTHLY    AND    ANNUAL    VITAL    STATISTICS    OF    THE    PRINCIPAL    PORTS    AND    CITIES. 
REPORT    ON    THE   ADOPTION    OF   THE    BERTILLON    NOMENCLATURE. 

In  the  capital,  as  in  the  provinces,  a  complete  system  of  statistics  has  been 
kept  for  many  years.  Only  a  few  of  the  provinces,  the  less  wealthy,  have  no 
complete  system  of  statistics,  but  this  will  be  remedied  as  circumstances  permit. 
As  to  mortality,  it  suffices  to  state,  in  general  terms,  that  in  Buenos  Ayres,  for 
many  years  it  has  ranged  from  16  to  19  per  1,000,  notwithstanding  the  fact  that 
many  persons  from  the  interior  towns  come  to  Buenos  Ayres  to  die,  as  in  any 
other  large  capital. 

X. 

PROPHYLAXIS     OF    INTERNATIONAL    TRAFFIC    EITHER    BY     SEA    OR    LAND,    IN     CASE    OF 
CONTAGIOUS    AND    QUARANTINE    DISEASES. 

Under  Nos.  I,  II  and  VI  we  have  stated  how  our  prophylactic  service  has 
been  organized,  and  which  are  the  principles  adopted  and  fixed  by  the  Rio  de 
Janeiro  Convention  in  1904,  with  Brazil,  Uruguay  and  Paraguay.  The  spirit  of 
this  Convention  and  general  rules  agree  with  the  Paris  Convention  in  1903  and 
that  of  Washington  in  1905.  We  again  beg  to  call  attention  to  the  great  im- 
portance of  observing  cholera  carriers,  whether  convalescing  from  the  disease, 
or  in  good  health  but  coming  from  infected  districts. 

XI. 

SANITARY    LAWS    ON    IMMIGRATION. 

All  we  can  say  is  that  our  laws  prohibit  the  entry  into  our  country  of  any 
person  suffering  from  chronic  contagious  diseases,  especially  trachoma  and 
leprosy.  Persons  unfit  for  work  or  over  60  years  of  age  [except  when  they 
have  relatives  in  the  country,  under  certain  conditions]  are  debarred,  as  well  as 
adventurers  or  fugitives  from  justice. 

XII. 

ADOPTION    OF    MARITIME    SANITARY    PAPERS    APPROVED    BY    THE    FOURTH    CONFERENCE. 

Our  country  did  not  attend  said  conference. 


REPORT  OF  DR.  CLAUDIO  SANJINES,  BOLIVIAN  DELE- 
GATE. 

Mr.  President  and  Messrs.  Delegates :  The  Bolivian  Government  having  been 
invited  to  participate  in  the  Fifth  Sanitary  Conference  of  the  American  States, 
has  appointed  me  its  delegate.  To  comply  with  the  provisional  program  of  this 
conference  it  would  have  been  my  pleasure  to  submit  a  special  report  on  the 
progress  of  sanitation  in  the  principal  cities  in  Bolivia.  But  unfortunately  I 
was  appointed  at  the  last  moment  and  have  not  been  able  to  gather  other  data 
than  that  dealing  with  the  general  sanitary  conditions  of  Bolivia,  a  few  diseases 
in  the  Colonias  Territory,  and  some  data  relative  to  climatology  and  the  sani- 
tary conditions  of  La  Paz. 

Sanitary  Organization. 

The  municipal  organic  law  gave  authority  to  municipalities  to  deal  with  all 
sanitary  problems ;  this  authority,  however,  was  generally  ineffective  and  in- 
sufficient. In  view  of  this  fact  Senator  Andres  S.  Muhoz,  a  distinguished  physi- 
cian, without  trying  to  abolish  such  authority,  prepared  a  project  of  a  General 
Public  Sanitary  Law,  in  order  to  create  a  sanitary  administration  dependent  on 
the  Executive  Power,  having  the  fullest  authority,  under  a  Director  General, 
directors  of  Departmental  Sanitation  and  provincial  physicians.  This  project 
after  being  carefully  considered  by  the  Faculty  of  Medicine  of  La  Paz,  was 
submitted  to  the  National  Congress,  and  has  become  a  law  of  the  republic.  I 
deem  it  an  honor  to  have  been  the  President  of  the  Medical  Association  when 
this  law  was  under  discussion. 

The  Government,  with  the  advice  of  the  Medical  Association,  engaged  the 
services  of  a  specialist  in  Germany  as  Director  General.  Unfortunately  the  per- 
son engaged,  a  member  of  the  University  of  Freiburg,  did  not  satisfy  the  wishes 
of  the  Government,  and  was  relieved  from  further  duty.  The  National  Con- 
gress is  at  this  moment  discussing  an  appropriation  for  the  reorganization  of 
the  Service,  with  a  competent  personnel. 

Compulsory  Vaccination  and  Revaccination. 

I  believe,  gentlemen,  that  if  there  are  epidemic  diseases  hard  to  fight  against, 
this  cannot  be  said  any  longer  of  smallpox,  which  besides  making  many  victims, 
leaves  indelible  marks  on  the  skin,  produces  blindness,  etc.  To  cope  with  this 
loathesome  and  terrible  disease,  we  have  today  a  most  powerful  arm,  vaccine 
•virus.  And  I  want  right  here  to  submit  a  motion  to  the  consideration  of  this 
Conference,  and  it  is  to  recommend  that  the  recommendation  of  the  Third  Inter- 
national Sanitary  Conference  held  in  Mexico  in  1907,  in  reference  to  compulsory 
vaccination,  be  not  ignored.  Smallpox  has  also  made  its  ravages  in  Bolivia  in 
former  years,  and  the  National  Congress  has  passed  a  law  which  has  been  pro- 
mulgated by  the  Executive,  providing  for  compulsory  vaccination  and  revaccina- 
tion. In  compliance  with  this  law,  the  proper  sanitary  officers  go  from  house  to 
house  within  the  infected  territory,  to  vaccinate  all  individuals.  There  are  also 
dispensaries  where  on  certain  days  vaccination  is  performed.  We  are  fortunate 
to  have  in  Bolivia  in  the  "Sucre  Medical  Institute"  a  vaccine  division,  founded 
in  1898.  It  is  now  progressing  under  the  able  direction  of  Doctor  Nicolas  Ortiz, 
and  producing  a  virus  which  has  been  most  successful  both  at  home  and  abroad. 
I  believe  that  in  1907,  the  president  of  the  institute,  Dr.  M.  Cuellar,  had  the 
virus  tested  and  the  report  stated  that  it  ranked  among  the  best  of  its  kind  pre- 
pared in  South  America.  The  best  proof  of  this  lies  in  the  fact  that  smallpox 
has  disappeared  in  Sucre.  We  are  grateful  for  the  excellent  work  of  the 
"Sucre  Medical  Institute." 

Potable  Water. 

The  Bolivian  Government,  fully  aware  that  the  principal  factor  in  the  sani- 


82  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

tation  of  a  town  is  a  supply  of  good  drinking  water,  has  been  expending  for 
several  years  large  sums  for  the  improvement  of  the  water  system,  by  means 
of  modern  piping  and  filtration  plants.  All  municipalities  have  contributed  to 
this  work  within  their  means.  Further  reference  to  this  subject  will  be  made 
later  on.  According  to  my  information  obtained  from  our  Treasury  Depart- 
ment, during  the  last  few  years  the  Government  has  spent  in  the  improvement 
of  the  water  system  of  the  cities  of  Cochabamba,  La  Paz,  Potosi,  Oruro,  Tarija, 
Santa  Cruz,  Trinidad,  Padilla,  Capinota,  Punata  and  Totora,  the  amount  of 
$3,346,449,  including  in  this  sum  the  works  to  bring  water  from  Cajamarca 
to  Sucre.  A  large  order  for  water  pipes  has  been  given  lately  to  a  German  firm 
for  the  cities  of  La  Paz,  Cochabamba,  Trinidad  and  Caraza. 

National  Institute  of  Bacteriology. 

This  institute,  only  recently  created,  due  to  the  initiative  of  President  Ismael 
Montes,  is  working  satisfactorily  in  La  Paz,  under  Dr.  Nestor  Morales  Villazon, 
who  was  sent  by  the  Government  to  Europe  to  make  certain  special  research. 
The  first  work  of  the  institute  has  been  devoted  to  the  bacteriological  analysis 
of  the  potable  waters  of  La  Paz  showing  the  improvement  attained  by  the  use 
of  the  new  pipes  and  filters.  For  instance,  the  waters  of  Challapampa  at  the 
time  of  the  old  system  gave  6,818,000  bacterise  per  litre,  and  later  3,750,000  and 
1,000,000,  which  translated  into  plain  facts  show  an  enormous  number  of  in- 
fectious diseases  of  the  digestive  organs,  and  typhoid  fevers,  particularly  in 
children.  After  the  new  system  had  been  in  use  the  examination  of  the  water 
showed  first  1,278,000,  then  700,000,  then  145,000,  and  finally  63,000  bacterise  per 
litre,  while  typhoid  has  almost  disappeared,  and  the  infections  of  the  intestinal 
canal  have  decreased. 

The  species  most  frequently  found  are  colicomunis,  proteus  vulgaris,  fluoresens 
putridas  and  fluoresens  liquificens.  At  present  the  institute  is  engaged  in  the 
examination  of  the  waters  of  Milluni,  which  I  believe  to  be  pure  as  they  are 
taken  at  their  source,  sent  to  the  filters  and  thence  distributed  through  first- 
class  piping. 

Dr.  Morales'  work  with  the  Eberth  bacillus  is  worthy  of  consideration.  In 
virulent  cultures  from  Europe  and  isolated  species  in  patients  in  La  Paz,  he  has 
found  that  the  bacteria^  protoplasm,  from  the  2d  and  3d  culture,  a  degenerative 
process,  inoculated  on  animals  give  unimportant  reaction.  He  has  made 
the  same  observation  as  regards  the  Koch  bacillus.  Inoculations  on  horses  with 
virulent  European  cultures  and  tubercular  sputa,  only  show  a  rise  in  temperature 
and  decrease  in  weight,  the  horses  having  improved  rapidly,  all  signs  of  inocu- 
lation having  disappeared.  Dr.  Morales  believes  that  at  an  altitude  of  3,630 
metres  above  the  level  of  the  sea  the  defense  of  the  phagocites  is  most  powerful. 

To  investigate  the  popular  belief  that  syphilis  is  found  in  the  llama,  several 
have  been  inoculated  with  the  virus,  with  negative  results.  The  investigations 
of  Dr.  Morales  on  blood  from  malarial  patients  from  the  La  Paz  creeks,  have 
shown  the  existence  of  the  Laveran  hematozoa  in  all  forms,  mainly  as  a  rosette. 
The  foregoing  suffices  to  show  that  the  Bacteriological  Institute  is  a  powerful 
agent  in  hygienics. 

Malaria. 

From  the  provisional  program  of  the  Fifth  Sanitary  Conference  a  special  topic 
has  been  omitted  for  the  discussion  of  sanitary  measures  against  malaria,  not- 
withstanding that  the  Delegate  from  Costa  Rica  to  the  Fourth  Conference  sub- 
mitted a  motion  calling  for  the  appointment  of  an  international  committee  for 
the  purpose  of  preparing  a  handbook  in  plain  language  so  that  all  may  under- 
stand it  to  fight  against  malaria,  such  work  to  be  submitted  to  this  Conference. 

If  malaria  is  only  known  in  the  northern  portion  of  Chile,  on  the  other  hand 
for  the  great  majority  of  the  delegates  here  present,  this  must  be  a  topic  of  the 
greatest  importance,  as  malaria  is  endemic  in  tropical  countries.  I,  therefore, 
beg  to  suggest  especially  to  such  of  the  delegates  as  have  a  better  knowledge  of 
the  disease,  to  consider  at  this  meeting  how  to  make  effective  Dr.  Rojas'  motion. 
It  would  be  most  important  to  me,  and  to  Bolivia  an  invaluable  service,  if  I 
could  take  back  to  my  country  a  complete  report,  not  only  of  the  modern  theories 
on  malaria  but  also  on  the  elements  at  the  command  of  science  to  fight  against 


FIFTH   INTERNATIONAL  SANITARY   CONFERENCE.  83 

the  disease.     I  feel  sure  that  my  suggestion  will  be  acted  upon  when  my  col- 
leagues learn  of  the  ravages  malaria  has  done  in  some  sections  of  Bolivia. 

Distribution  of  Malaria  in  Bolivia. 

An  examination  of  the  distribution  of  malaria  in  Bolivia  clearly  demonstrates 
that  this  endemic  disease  does  not  exist  in  cold  countries  and  increases  as  a 
warmer  climate  is  approached ;  that  in  the  temperate  regions  it  only  makes  its 
appearance  during  the  heated  season;  that  malaria  does  not  require  a  warm 
climate  merely,  but  also  humidity  and  stagnant  waters,  developing  especially  in 
low,  undrained  territory,  in  places  where  humidity  is  constant  due  to  superficial 
underground  water;  in  places  subject  to  inundation,  and  near  rivers  and  par- 
ticularly small  streams.  According  to  this,  malaria  is  found  in  Bolivia  as  fol- 
lows : 

Department  of  Chuquisaca:  Province  of  Tomina  and  basins  of  the  Pilcomayo, 
Churumatos  and  Oroconta;  in  Camataqui,  a  special  type  accompanied  often  by 
hemorrhages  and  cirrhosis  of  the  liver.  It  is  very  resistent  to  the  quinine 
treatment. 

Department  of  La  Paz:     In  most  of  its  provinces. 

Department  of  Beni:    At  the  capital  and  a  few  other  towns. 

Department  of  Cochabamba:  In  some  of  its  provinces,  mainly  in  Mizque  and 
the  swampy  regions. 

Department  of  Potosi:  In  some  of  its  provinces,  particularly  the  proximity 
of  the  Pilcomayo  river. 

Department  of  Tarija:     The  Gran  Chaco  and  Tarija. 

Department  of  Santa  Cruz:     In  some  portions  of  this  Department. 

As  may  be  seen,  Bolivia  is  a  prey  to  malaria.  The  ravages  of  malaria,  of 
course,  are  better  checked  at  points  in  the  vicinity  of  cities  and  towns.  As  I  have 
remarked,  malaria  is  prevalent  along  the  basins  of  the  large  rivers,  in  the 
regions  where  rubber  is  extracted,  and  trade  posts  have  naturally  been  estab- 
lished. The  distribution  of  malaria  in  Bolivia  may  be  established  in  a  general 
way  along  the  great  rivers  and  all  their  respective  affluents.  The  presence  of 
rubber  in  the  northwestern  portion  of  Bolivia,  which  naturally  attracts  trade, 
and  certain  difficulties  with  the  neighboring  countries  made  necessary  during  a 
few  years  the  sending  of  troops  to  the  frontier,  which  fell  in  great  numbers  the 
victims  of  malaria.  This  is  now  a  matter  of  history,  because  the  sanitation  of 
those  dangerous  regions  has  been  perfected  to  such  an  extent  that  there  exist 
now  prosperous  towns,  among  them  some  of  the  healthiest  in  Bolivia.  Surgeon 
General  Elias  Sagaruaga  of  the  Bolivian  Army,  who  went  to  that  region  with 
the  expedition  in  1903,  has  submitted  to  the  Supreme  Government  a  set  of  rules 
against  malaria  which  it  is  expected  will  be  placed  in  the  hands  of  those  living 
in  malarial  zones.  I  shall  not  enter  into  a  discussion  of  the  disease,  but  will 
simply  state  that  malaria  in  Bolivia  is  present  in  all  its  forms. 

Espundia. 

I  have  nothing  to  add  to  the  monograph  submitted  by  my  distinguished  col- 
league, Dr.  Elias  Sagaruaga,  at  the  Fourth  Scientific  Congress  (First  Pan 
American)  held  in  this  city  in  December,  1908,  under  the  title:  "Tropical 
Pathology  of  Espundia."  It  is  the  Buba  according  to  Breda,  of  Padova,  Italy, 
and  may  be  confounded  with  the  Pian  and  Frambesia.  Breda  believes  to  have 
discovered  the  bacillus  of  Espundia,  and  has  studied  this  disease  in  the  laborers 
returning  to  Italy  from  Brazil,  and  in  1907  published  his  work  "La  Bouba  del 
Brasile."  It  appears  that  Breda's  theories  are  accepted  by  French  dermatolo- 
gists. The  Breda  bacillus  cannot  be  cultivated,  nor  has  it  shown  any  lesions 
when  inoculated  in  the  ear  of  a  rabbit.  Maiocchi  and  Bosellini  have  described 
another  bacillus.  Castellani  maintains  that  yaws,  pian  and  buba  are  one  and  the 
same  thing ;  that  the  tardy  localization  in  the  mucus  membrane  can  be  compared 
to  the  manifestations  of  syphilis,  and  that  the  real  pathogenic  agent  is  a  pro- 
tozoa the  treponema  pertenue,  spiral,  belonging,  because  of  its  characteristics, 
more  to  the  spirochetes  than  to  the  treponemas,  and  similar  to  the  schandin. 

The  characteristics  of  the  pathological  anatomy  of  espundia  are  the  plasmatic 
cells ;  the  lesions  are  both  of  the  skin  and  the  mucus  membrane,  very  similar  to 


84  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

frambesia.  Breda  maintains  that  pian  and  yaws  are  very  different  from  buba, 
and  that  this  is  more  like  frambesia  and  espundia.  The  matter  has  not  been 
definitely  settled.  As  espundia  is  neither  contagious  nor  easy  to  spread,  the 
prophylactic  measures  cannot  be  positive.  It  is  better,  however,  to  isolate  the 
patients.  The  employ  of  gaiters  as  a  protection  against  insect  bites  and  scratch- 
ing is  recommended.  Gaiters  may  be  substituted  by  puttees  in  damp  places. 
Malnutrition  is  another  cause  of  ulcers.  Besides  the  remedies  known  in  La 
Paz,  Salvarsan  or  606  has  been  used.  While  there  has  been  a  certain  measure 
of  success,  it  cannot  be  compared  with  that  attained  in  the  treatment  of 
syphilis.  I  believe  that  improvement  in  a  large  number  of  patients  has  been 
due  to  the  use  of  arsenic. 

La  Paz  is  subject  to  atmospheric  variations  from  one  day  to  another  and  even 
during  the  same  day.    These  variations  are  productive  of  catarrhal  affections.- 

As  the  hospital  records  are  generally  used  for  statistical  purposes  as  regards 
prevailing  diseases,  and  these  have  been  kept  without  entering  the  name  of  the 
place  where  the  patients  come  from,  many  coming  from  the  provinces,  no 
accurate  data  can  be  had.  This  will  be  remedied  in  future,  thus  facilitating 
our  statistical  work.     Death  certificates  should  also  contain  this  information. 

The  Municipality  of  La  Paz  will  soon  have  a  bureau  for  the  collection  of  vital 
statistics. 

From  incomplete  statistical  data  on  burials  we  find  that  from  1900  to  1910  the 
number  of  deaths  from  fever  (generally  typhoid)  was  1,490;  measles,  children 
from  1  to  7  years  of  age,  2,020;  from  8  to  15,  596;  whooping  cough,  children  be- 
tween 1  and  7  years  of  age,  2,398;  between  8  and  15,  928;  gastro-intestinal  dis- 
eases, children  from  1  to  7,  1,859;  from  8  to  15,  259;  smallpox,  children  between 
1  and  7,  1,055;  from  8  to  15,  281;  from  16  to  21,  148;  from  30  to  41,  40;  dysen- 
tery, 1,766  deaths;  bronchitis,  753;  grippe,  123;  pneumonia,  1,702;  gastro- 
intestinal infections,  288;  malaria,  22;  heart  disease,  728;  pleurisy,  501;  tuber- 
culosis, 251,  etc. 

From  the  foregoing  a  fair  idea  may  be  had  of  the  dominant  diseases,  especially 
the  infectious  and  contagious  diseases.  Lack  of  hygiene,  and  other  habits  par- 
ticularly among  the  lower  classes,  is  mainly  responsible  for  this  condition.  Two 
other  factors  are  also  important  in  this  connection,  atmospheric  changes  and 
the  habit  of  appealing  to  the  hospital  when  the,  disease  is  so  far  advanced  that 
there  is  hardly  any  possibility  of  recovery. 

Fortunately  for  us  neither  cholera  nor  bubonic  plague  have  so  far  visited 
Bolivia.  It  behooves  the  sanitary  authorities  of  Antofagasta,  Mollendo  and 
Arica  to  do  all  in  their  power  to  prevent  the  introduction  of  these  diseases,  by 
the  proper  sanitation  of  their  ports.  In  case  cholera  and  the  plague  should 
visit  Bolivia,  the  resolutions  adopted  by  this  conference  will  be  carried  into 
effect. 

Municipal  Action. 

The  municipality  of  La  Paz,  in  the  discharge  of  its  duties,  is  doing  the  utmost 
for  public  sanitation.  Its  best  work,  however,  is  the  damming  up  in  a  reservoir 
the  waters  from  the  Choqueyapa,  on  which  the  city  of  La  Paz  is  built,  as  well  as 
the  waters  descending  from  the  glaciers  of  Huayna-Potosi  and  Chacaltaya. 
The  reservoir  holds  sufficient  water  to  feed  the  other  city  deposits  with  a 
constant  flow  of  about  500  litres  per  second,  night  and  day,  at  all  times  and  in 
all  seasons.  From  the  reservoir  the  waters  are  sent  to  the  Achicola  filters, 
through  two  systems  of  steel  pipes,  one  measuring  12,000  meters  in  length  with  a 
uniform  interior  diameter  of  500  millimeters,  and  the  other  measuring  100,000 
meters,  with  same  interior  gauge.  Now  the  inhabitants  of  La  Paz  have  a  daily 
water  supply  of  about  500  litres  per  head,  twice  as  much  as  the  daily  water 
supply  of  larger  capitals  per  capita.  Besides  this  supply  from  the  Milluni  we 
also  have  that  derived  from  Tembladerani,  which  has  been  rated  as  ideal,  by  the 
Director  of  the  Chemical  Laboratory  of  Santiago,  Chile.  The  Municipal  Coun- 
cil of  La  Paz  is  now  engaged  in  the  preparation  of  the  necessary  plans  for  a 
sewerage  system  costing  about  $6,500,000,  thus  insuring  the  almost  perfect  sani- 
tation of  La  Paz. 

The  Municipality  has  also  charge  of  the  hospital  service;  one  for  men  and 
the  other  for  women,  besides  a  lazaretto  for  both  sexes  for  the  isolation  of  such 
patients  as  may  require  it.  Plans  for  a  model  hospital  are  now  under  considera- 
tion, to  be  erected  on  one  of  the  best  sites  in  the  city.     Conjointly  with  the 


FIFTH    INTERNATIONAL  SANITARY   CONFERENCE.  85 

Hospital  Service  there  is  the  public  charity  institutions  with  special  sections  for 
the  treatment  of  the  eyes,  children's  diseases,  medicine,  surgery,  gynecology,  etc., 
and  a  special  section  devoted  to  emergency  cases. 

The  Bureau  of  Hygiene  has  a  staff  devoted  to  sanitary  house  to  house  inspec- 
tion, reporting  on  contagious  and  infectious  diseases,  attending  to  the  isolation 
of  patients,  disinfection  of  infected  rooms,  analysis  of  potable  water,  drinks, 
foods,  etc.,  in  accordance  with  the  regulations. 

The  Municipality  has  also  devoted  special  attention  to  the  protection  of  society 
against  venereal  and  syphilitic  diseases.  There  is  now  a  regulation  in  force 
regarding  prostitution,  prepared  by  Dr.  E.  Sagarnaga  and  myself. 


REPORT  OF  DOCTORS  ISMAEL  DA  ROCHA  AND  AN- 
TONIO FERRARI,  BRAZILIAN  DELEGATES. 

I.  The  Sanitary  Police  regulations  and 'sanitary  measures  adopted  by  Brazil 
since  the  Fourth  Conference,  are  the  same  as  those  in  force  in  1907,  and  sub- 
mitted to  the  Third  Conference.  They  have  not  been  altered  by  new  federal 
legislation.  To  this  wise  legislation  Brazil  owes  the  extinction  of  yellow  fever 
in  Rio  de  Janeiro,  and  the  ever  increasing  success  in  its  campaign  against  all 
contagious  diseases. 

II.  Brazil  has  complied  with  the  resolutions  adopted  in  the  preceding  con- 
ferences, as  shown  in  the  publications  we  are  distributing,  and  other  official  acts 
which  cannot  be  included  in  this  report  because  of  their  extension. 

III.  Brazil  has  complied  with  the  Washington  Convention  of  1905,  and  the 
amendments  to  Art.  9,  made  by  the  Fourth  International  Sanitary  Conference, 
and  the  Fourth  Pan  American  Conference  of  Buenos  Aires.  Our  Brazilian 
sanitary  laws  now  in  force,  as  shown  by  the  evident  good  results  obtained  in 
sanitation  all  over  the  country,  lead  to  the  attainment  of  the  final  results  aimed 
at  by  the  convention  and  amendments. 

IV.  Nothing  to  report. 

V.  The  sanitation  of  the  city  of  Rio  de  Janeiro,  capital  of  Brazil,  and  of  the 
cities  and  ports  with  which  there  exists  an  international  trade  and  commerce, 
has  been  completed  in  some  instances  and  is  being  established  in  others,  with  the 
aid  of  the  Federal  Government.     The  following  works  may  be  mentioned: 

1.  Port  of  Manaos :  Work  done  under  contract  between  the  Federal  Gov- 
ernment and  the  "Manaos  Harbour  Corporation,"  estimated  at  several  millions 
of  dollars.  There  have  been  in  Manaos  sporadic  cases  of  yellow  fever,  against 
the  spread  of  which  such  sanitary  measures  have  been  taken  as  have  proven 
successful  in  Rio  de  Janeiro  and  Para.    The  port  works  are  rapidly  progressing. 

2.  Port  of  Belem  (Para).  The  works  contracted  for  by  the  National  Govern- 
ment with  the  "Port  of  Para  Corporation,"  are  progressing  satisfactorily,  at  a 
cost  of  about  one  million  dollars.  Port  free  from  plague,  yellow  fever  or 
cholera. 

3.  Port  of  Sao  Luiz  (Maranhao).  Works  under  the  National  Government, 
wharves,  dredges,  etc.    No  yellow  fever. 

4.  Port  of  Fortaleza  and  Port  Camousin  (Ceara).  Healthy  belt.  Works  done 
by  National  Government  to  benefit  commerce. 

5.  Port  Cabedello  (Parahyba).  Healthy  belt.  Dredging  done  by  National 
Government. 

6.  Same  remarks  apply  to  Port  of  Natal   (Rio  Grande  do  Norte). 

7.  Port  of  Recife  (Pernambuco).  A  colossal  undertaking,  costing  millions  of 
dollars.     Sanitary  conditions  most  satisfactory. 

8.  Port  of  Bahia.  The  work  progresses  most  actively.  Splendid  work,  as  good 
as  that  of  Pernambuco.     Good  sanitary  conditions,  and  a  fine  port. 

9.  Port  Victoria  (Spiritu  Santo).     Work  under  way.     Good  sanitation. 

10.  Port  of  Rio  de  Janeiro.  Under  contract  with  Walker  &  Co.  To  be  com- 
pleted very  soon.  Wharves  extending  a  long  distance  along  the  water  front. 
Mortality  which  not  many  years  ago  was  about  56  per  1,000,  now  shows  less 
than  20  per  1,000. 

11.  Port  of  Nichtheroy,  opposite  Rio  de  Janeiro  on  the  same  bay.  Sanitary 
works  progressing  under  contract. 

12.  Port  of  Santos  (S.  Paulo).  Healthy.  Works  completed.  A  healthful, 
flourishing  city.    Large  trade. 

13.  Port  of  Paranagua  (Parana).  Healthy.  Works  of  improvement  pro- 
gressing under  contract.  Estimated  in  several  millions.  Curityba,  the  capital  of 
the  State,  is  a  prosperous  city. 

14.  Port  of  Florianopolis  (Santa  Catharina).  Healthy.  Improvements  in  the 
smaller  ports  by  the  National  Government. 

15.  Port  of  Rio  Grande.  Most  healthy.  Difficult  navigation  on  account  of 
shifting  sand  banks.     Works  of  improvement  under  a  French  Company. 


68  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

16.  Port  of  Corumba  (Matto-Grosso).  A  river  port.  Works  under  contract 
and  progressing. 

VI.  The  prophylactic  measures  against  plague  and  cholera  are  the  same  as 
those  contained  in  the  report  submitted  to  the  Third  Sanitary  Conference  of 
Mexico  by  Dr.  Oswaldo  Cruz.  As  to  cholera,  it  has  not  made  its  appearance  in 
Rio  de  Janeiro  for  many  years.  The  sanitary  police  of  ports  is  carried  on,  most 
successfully,  in  accordance  with  the  convention  in  force. 

VII.  It  is  very  difficult  to  tell  when  a  person  may  be  considered  as  an  immune 
from  yellow  fever.  As  there  is  no  serum  against  the  disease,  immunity  may 
depend  on  acclimatization.  Two  years  may  suffice  if  it  is  a  contaminated  zone, 
but  if  the  person  goes  to  other  countries,  traveling  destroys  immunity  if  he  re- 
turns to  the  contaminated  place. 

VIII.  The  national  and  international  prophylaxis  of  tuberculosis,  venereal 
diseases,  smallpox,  malaria,  trachoma,  leprosy,  are  shown  in  the  tables  we  submit. 
Scleroma  is  unknown  in  Brazil. 

IX.  Bertillon's  nomenclature  has  been  adopted  in  Rio,  as  shown  in  our  sta- 
tistics. The  monthly  and  annual  mortality  in  the  city  of  Rio  de  Janeiro,  is 
shown  in  subjoined  table  covering  the  last  50  years,  for  periods  of  5  years. 

Years.  Rate  per  1,000  inhabitants. 

1859-1863 58.43 

1864-1868 49.03 

1869-1873 49.12 

1874-1878 44.40 

1879-1883 34.71 

1884-1888 30.40 

1889-1893 38.20 

1894-1898 33.16 

1899-1903 27.86 

1904-1908 26.08 

The  period  of  1909-1912  is  lacking,  but  the  rate  is  lower  than  20  per  1,000. 
There  was  in  1908  a  serious  epidemic  of  smallpox,  and  only  a  few  cases  in  1909 ; 
only  1  case  in  1910,  and  in  1911,  3  cases,  up  to  the  day  of  our  departure  from 
Rio  de  Janeiro. 

As  regards  other  ports  these  figures  are  for  1910. 

igio.  Rate  per  1,000  inhabitants. 

Manaos 35.15 

Para 32.10 

Nichtheroy 32.15 

Santos  (S.  Paulo)    20.14 

Paranagua 18.22 

Florianopolis 22.69 

Porto-Alegre 26.55 

X.  Brazil  has  adopted  the  sanitary  measures  recommended  at  former  con- 
gresses, including  the  convention  signed  in  Rio,  June,  1904,  by  the  representatives 
of  Argentina,  Uruguay,  Paraguay  and  Brazil,  and  now  in  force,  after  due  ap- 
proval by  the  respective  governments. 

Nowhere  in  Brazil  are  patients  sent  back  to  their  places  of  origin ;  quarantine 
was  suppressed  in  certain  cases  and  enforced  against  cholera,  yellow  fever  and 
plague.  Attention  has  been  paid  to  proper  isolation  of  patients  or  suspected 
cases,  to  sanitary  vigilance,  disinfection,  vaccination,  etc.,  according  to  the  dis- 
ease. Communication  cannot  be  suspended  nor  vessels  denied  port  for  sanitary 
reasons.  Sanitary  cordons  are  abolished.  It  has  been  fully  demonstrated  in 
Brazil  that  the  principles  adopted  in  the  convention  referred  to  are  ample  for 
the  sanitation  of  any  port. 

XI.  The  sanitary  laws  on  immigration  are  derived  in  Brazil  from  the  general 
sanitary  legislation.  Besides  these  regulations,  there  is  in  the  island  of  Flores, 
Rio  de  Janeiro,  a  modern,  well-equipped,  sanitary  establishment  for  immigrants, 
with  an  excellent  medical  service,  and  all  sanitary  conveniences. 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  89 

XII.  The  sanitary  documents  adopted  in  the  Fourth  Conference,  do  not  alter 
in  any  way  the  documents  adopted  and  in  use  by  Brazil. 

An  accurate  idea  of  the  mortality  from  yellow  fever  in  Rio  de  Janeiro  may 
be  had  from  the  following  table  giving  official  figures : 

Cases. 

1901 299 

1902 984 

1903 584 

1904 48 

1905 289 

1906 43 

1907 39 

1908 9 

1909 0 

1910 0 

These  figures  are  most  eloquent. 

As  regards  bubonic  plague,  a  few  cases  break  out  in  the  spring  of  the  year,, 
which  however  disappear  before  the  application  of  appropriate  prophylactic- 
measures. 

In  conclusion  we  beg  to  submit  the  following  figures  showing  the  present 
population  of  Brazil : 

Direction  General  of  Statistics.  Population  of  Brazil  in  1910,  estimated  by 
Municipalities. 

States.  Population. 

Alagoas 863,522 

Amazonas 421,702 

Bahia 2,443,848 

Ceara 1,001,929 

Distrito  Federal  914,610 

Espirito  Santo   331,269 

Goyaz 303,851 

Maranhao 614,893 

Malto-Grosso 150.071 

Minas  Geraes   4,237,027 

Para 581,317 

Parahyba 623,472 

Parana  530.228 

Pernambuco 1,435.004 

Piauhy 438,778 

Rio  de  Janeiro   1,057.275 

Rio  Grande  do  Norte 317,199 

Rio  Grande  do  Sul  1,554,000 

Santa  Catharina  399.510 

S.  Paulo  3,427,312 

Sergipe 452,544 

Territorio  do  A  ere  76,065 

Total  population   22,175,426 


REPORT  OF  THE  CHILEAN  DELEGATION. 

Messrs.  Delegates :  In  accordance  with  the  program  for  this  Conference, 
the  Chilean  Delegation  has  the  honor  to  submit  a  brief  resume  of  the  prog- 
ress achieved  by  the  country  in  public  hygiene  during  the  last  few  years,  par- 
ticularly the  last  two. 

In  connection  with  this  paper  an  exhaustive  report  has  been  printed  and 
distributed,  under  the  title  of  "Public  Hygiene  and  Assistance  in  Chile,"  and 
a  sanitary  exhibition  has  been  installed,  which  will  be  shown  to  the  Delegates, 
presenting  some  features  of  our  sanitary  progress. 

The  backward  state  of  our  sanitary  legislation  and  the  defective  organiza- 
tion of  our  sanitary  service,  led  us  to  concentrate  our  efforts  during  the  last 
few  years  into  the  radical  modification  of  that  state  of  affairs. 

A  Sanitary  Code  is  now  pending  before  the  Chamber  of  Deputies,  embody- 
ing all  the  necessary  reforms  and  providing  for  the  required  legislation  on  so 
important  a  subject.  It  is  expected  that  the  bill  will  soon  be  made  into  law, 
and  that  it  will  surely  be  productive  of  great  benefits  for  the  country. 

The  sanitation  of  cities  and  ports  has  been  the  subject  of  the  Government's 
best  attention.  Adequate  water  works  have  been  built  for  the  cities  of  Copiapo, 
Vallinar,  Coquimbo,  Combarbala,  Ligua,  Quilpue,  Casablance,  San  Jose  de 
Maipo,  San  Bernardo  and  suburbs,  Carepto,  Talca,  Linares,  Parral,  Cobque- 
cura,  San  Carlos,  Chilian,  Coelemu,  Talcahuano,  Concepcion,  Los  Angeles, 
Nacimiento,  Mulchen,  Angol,  Collipulli,  Victoria,  Traiguen,  Temuco,  Valdivia, 
and  Osorno ;  30  cities  in  all,  with  a  population  of  over  350,000.  The  total  cost 
of  these  works,  most  of  which  have  been  completed,  is  £603,559.  In  all  of 
them  allowance  has  been  made  for  an  increase  in  population  of  from  80  to 
100  per  cent,  and  the  capacity  is  150  liters  a  day  per  person. 

There  have  been  completed,  or  are  nearing  completion,  the  sewer  systems  of 
Antofagasta,  Taltal,  Serena,  Curico,  Talca,  Chilian,  Concepcion  and  Valdiva; 
8  cities  in  all,  at  a  total  cost  of  £594,553. 

The  sewer  system  of  Santiago,  the  construction  of  which  was  begun  on 
July  10,  1905,  and  completed  on  December  20,  1910,  serves  an  area  of  2,500 
hectares  and  its  length  is  370,000  meters.  It  has  cost  over  13,000,000  gold 
pesos  of  18  d.  At  present  over  3.500  are  connected  with  the  system.  All 
these  works  represent  an  approximate  expenditure  of  30,000,000  gold  pesos 
of  18  d. 

The  present  water  supply  of  the  capital  being  insufficient,  additional  works 
are  being  carried  on,  which  will  cost  nearly  12,000,000  gold  pesos  of  18  d. 

In  Valparaiso  also  additional  water  works  are  being  constructed,  the  pres- 
ent supply  being  inadequate.  The  cost  of  these  works  is  estimated  at  5,- 
000,000  gold  pesos  of  18  d.  Mention  should  also  be  made  of  the  definite 
paving  of  the  streets  of  Santiago  and  Valparaiso,  each  costing  £500,000  and 
£50,000,  respectively.  Another  important  work  is  the  reconstruction  of  Val- 
paraiso, the  cost  of  which  has  reached  57,500,000  pesos  paper. 

Among  sanitary  works  of  another  kind  we  may  mention  the  sanitation  of 
laborers'  houses  in  Santiago  and  other  parts  of  the  Republic,  with  the  indirect 
support  of  the  Government.  The  legislation  on  this  subject  is  based  upon 
the  law  of  February  20,  1906,  which  created  dwelling  boards  in  all  Depart- 
ments of  the  Republic.  A  later  law  authorized  the  Supreme  Dwelling  Board 
to  raise  a  loan  of  6,000,000  pesos  for  the  construction  of  model  houses  for 
laborers.  The  said  boards  are  empowered  to  carry  on  the  sanitary  inspection 
of  dwellings,  to  order  the  execution  of  improvements  and  to  close  unsanitary 
houses.  During  the  year  230  tenement  houses,  with  6,900  dwellers,  were 
closed  on  account  of  unsanitary  conditions.  During  the  same  period,  the 
Supreme  Board  authorized  the  opening  of  40  tenement  houses  with  2,500 
rooms,  costing  2,500,000  pesos.  The  same  board  has  also  inaugurated  100 
houses  for  laborers  in  the  town  of  San  Eugenio,  and  is  building  many  more 
in    different    wards    of    the    capital.      The    Mortgage    Bank    (Caja    de    Credito 


92  FIFTH    INTERNATIONAL  SANITARY  CONFERENCE. 

Hipotecario)  is  also  constructing  166  laborers'  houses,  at  an  expenditure  of 
1,700,000  pesos.  The  same  institution  has  bought  a  large  tract  of  land  valued 
at  1,053.335,  for  the  same  purpose.  It  is  also  going  to  build  dwellings  for 
small   farmers. 

The  government  has  already  issued  the  call  for  bids  for  the  construction  of 
the  Valparaiso  port  works,  the  approximate  cost  of  which  will  be  31,000,000 
pesos  gold  of  18  d. 

The  construction  of  the  port  of  San  Antonio  will  soon  be  undertaken  at  a 
cost  of  $1,175,000  pesos  gold  of   18  d. 

The  prophylaxis  of  the  diseases  enumerated  in  No.  8  of  the  program  is  not 
carried  on  satisfactorily   for  the  reasons  above  stated. 

Tuberculosis. — The  prophylaxis  of  this  disease  is  carried  on  specially  by  the 
anti-tuberculosis  leagues  of  Santiago  and  Valparaiso,  which  have  been  in  ex- 
istence for  some  years  and  are  subsidized  by  the  Government. 

In  Santiago,  besides  the  propaganda  work  done  in  different  ways,  and  par- 
ticularly to  a  special  publication  called  The  Social  Hygiene  Herald,  there  are 
public  dispensaries  and  a  maritime  sanitorium  in  Cartagena,  two  hours  by 
rail  from  the  capital. 

There  is  also  in  Santiago  a  special  hospital  for  consumptives,  with  pro- 
vision for  200  beds.  In  the  other  hospitals  no  cases  of  tuberculosis  are  al- 
lowed. 

In  Valparaiso,  the  prophylaxis  of  this  disease  is  principally  in  charge  of  the 
Bureau  of  Propaganda  against  Tuberculosis.  The  city  has  also  a  dispensary 
and  a  hospital  for  consumptives,  with  a  capacity  for  250  patients ;  and  the 
"Edwards  Sanotorium"  in  Los  Andes. 

In  Peha  Blanca  there  will  soon  be  opened  a  sanatorium  with  130  beds. 

Small-pox. — Not  having  a  law  making  vaccination  and  re-vaccination  com- 
pulsory, this  disease  prevails  in  an  endemic  form  and  appears  with  varying 
frequency.  From  1880  to  1907,  that  is  to  say,  during  28  years,  the  statistics 
record  144,000  cases  with  73,528  deaths,  or  an  average  of  2,626  deaths  per  year. 
During  that  period  7,401,900  vaccinations  were  made. 

Serious  epidemics  were  recorded  in  1880,  1886,  1890,  and  1905,  the  latter  with 
10,615  victims.  In  1910  there  were  1,929  deaths  from  small-pox,  and  in  the 
present  epidemic  at  Santiago,  673  deaths  have  been  recorded  from  January 
to  October.  In  1910  312,645  vaccinations  were  made,  of  which  111,122  were 
revaccinations. 

For  the  preparation  of  animal  vaccine  we  have  an  excellent  institute,  which 
has  recently  been  made  a  part  of  the  serotherapy  section  of  the  institute  of 
Hygiene.  In  1910  that  section  delivered  to  the  Central  Vaccination  Board 
78,380  tubes  of  virus.  This  body  has  charge  of  everything  connected  with 
vaccination. 

Malaria. — It  prevails  only  in  a  small  part  of  the  northern  end  of  the  country. 
Its  influence  in  our  demography  is  very  insignificant. 

Venereal  Diseases. — The  prophylaxis  of  these  diseases  is,  by  virtue  of  our 
political  constitution,  in  charge  of  the  municipalities. 

At  the  present  time  this  service  is  organized  in  the  ports  of  Arica,  Iquique, 
Antofagasta,  Tocopilla,  Taltal,  Coquimbo,  Valparaiso,  Constitucion,  Talca- 
huano,  Coronel,  Valdivia,  and  Punta  Arenas,  and  in  the  cities  of  Santiago, 
Talca.  Curico,  Chilian,  Concepcion,  San  Felipe,  Quillota,  Angol,  Los  Angeles, 
Arauco,  Rengo  and  Nueva  Imperial. 

The  medical  inspection  of  prostitutes  is  done  bi-weekly,  weekly  or  bi- 
monthly, either  in  houses  or  in  special  polyclinics.  The  isolation  of  con- 
tagious patients  is  not  compulsory,  but  is  enforced  more  or  less  rigidly  in  the 
various  cities. 

In  Santiago  there  are  polyclinics  and  special  hospital  wards  for  the  treat- 
ment of  these  cases.  In  the  national  navy  special  attention  is  given  to  the 
treatment  of  venereal  cases,  with  very  satisfactory  results. 

In  the  armv  the  rate  of  these  diseases  has  been  reduced  from  25.3  per  cent 
in  1907  to  14.5  per  cent  in  1910. 

Trachoma. — This  disease  was  imported  into  the  country  in  1881,  apparently 
by  a  Spanish  immigrant.  From  that  year  until  1889,  151  cases  were  verified  in 
the  eye  infirmaries  of  Santiago.  The  percentage  of  trachoma  patients  in  the 
total    number   of   cases   treated   in   the   infirmaries   of    Santiago,    has   increased 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  93 

from  0.5  per  cent  in  1895  to  an  average  of  3.1  per  cent  for  eleven  years.     The 
percentage  in  1910  was  8  per  cent. 

The  measures  now  enforced  to  prevent  the  importation  of  trachoma  cases 
are  confined  to  the  medical  examination  of  immigrants  upon  arrival. 

Leprosy. — This  disease  does  not  exist  in  Chile.  The  only  three  cases  so  far 
recorded  have  occurred  in  foreigners.  At  present  the  only  case  existing  (a 
negro  from  Jamaica)  is  isolated  in  one  of  the  Santiago  hospitals. 

Scleroma. — Up  to  the  present  date  35  cases  of  this  disease  have  been  ob- 
served in  different  parts  of  the  country. 

Yellow  Fever. — This  disease  is  unknown  in  Chile. 

Plague. — It  appears  in  an  endemic  state  in  the  northern  ports,  from  Arica 
to  Taltal,  inclusive,  since  1903.  The  first  epidemic  invaded  Iquique  (May, 
1903)  and  successively  the  other  ports,  in  subsequent  years,  as  far  north  as 
Arica  and  as  far  south  as  Taltal. 

At  various  times  there  have  been  small  epidemics  in  Valparaiso,  and  isolated 
cases  in  Santiago.  In  both  cities  the  focii  were  quickly  destroyed.  During 
the  last  two  years  the  plague  has  appeared  in  the  north  under  a  mild  form. 
In  1910  there  were  recorded  in  Arica,  Pisagua,  Iquique,  Tocopilla,  Mejillones, 
Antofagasta  and  Taltal,  232  cases  with  123  deaths.  During  the  first  five 
months  of  1911,  in  the  same  cities,  there  were  147  cases  with  59  deaths. 

The  fight  against  this  disease  has  been  principally  in  charge  of  the  Gov- 
ernment, with  the  usual  methods.  In  the  campaign  for  the  destruction  of 
rats,  mention  should  be  made  of  the  activity  displayed  by  the  Iquique  disin- 
fecting station  and  of  the  good  results  obtained  at  that  place  with  the  azoa 
virus.  The  Government,  through  the  Institute  of  Hygiene,  has  distributed 
free  of  charge  large  quantities  of  Yersin  serum  and  Haffkine  vaccine. 

Asiatic  Cholera. — During  the  last  years  the  Government  has  enforced  vig- 
orous defensive  measures  to  prevent  the  importation  of  this  disease.  Among 
those  measures  we  may  mention  the  sending  of  a  sanitary  inspector  to  Re- 
publics of  the  River  Plate;  the  purchase  of  Docker  barracks,  field  medicine 
chests,  and  field  laboratories  for  the  rapid  bacteriological  examination  of  the 
disease;  the  establishment  of  a  sanitary  station  in  Juncal  for  the  sanitary  sur- 
veillance of  the  frontier  traffic,  etc. 

For  the  prevention  of  the  introduction  of  exotic  diseases  through  maritime 
ports  there  have  been  established  a  permanent  sanitary  station  in  Arica  and 
a  provisional  one  in  Punta  Arenas,  which  will  be  made  permanent. 

Mention  should  also  be  made  of  the  disinfection  services  in  the  principal 
ports  and  of  the  twelve  disinfecting  stations  in  as  many  different  places  in 
the  Republic. 

With  regard  to  the  tenth  subject  of  the  program,  we  may  say  that  the  gov- 
ernment, besides  the  general  supervision  which  it  exercises  over  all  sanitary 
matters,  has  in  case  of  an  epidemic,  the  right  to  enforce  for  a  definite  period, 
and  the  consent  of  Congress  previously  obtained,  the  Law  of  Sanitary  Police, 
passed  on  the  30th  of  December,  1896.  By  virtue  of  this  law,  the  President 
is  empowered  to  close  the  maritime  and  land  ports ;  to  prescribe  quarantine 
measures,  compulsory  disinfection  of  passengers  and  cargoes,  and  to  adopt 
such  other  measures  which  he  may  deem  necessary  for  the  eradication  of  any 
of  the  epidemics  specified  in  the  regulations.  The  General  Health  Ordinance 
of  January  10,  1887,  specifies  the  sanitary  measures  that  may  be  adopted  by 
the  authorities. 

The  General  Board  of  Sanitation,  which  was  created  to  advise  the  Govern- 
ment in  sanitary  matters,  and  to  study  and  submit  health  and  prophylactic 
measures,  and  the  departmental  boards  of  sanitation,  were  abolished  on 
May  23,  1900,  and  the  Superior  Council  of  Health  was  organized  instead 
thereof.  The  provincial  councils  of  hygiene,  established  by  decree  of  Jan- 
uary 19,  1889,  were  also  reorganized  and  subdivided  into  the  present  Depart- 
mental Councils,  which  have  been  operating  since  the  10th  of  December,  1892. 
The  Law  of  Navigation,  in  force  since  June  24,  1878,  and  the  Maritime 
Health  Regulations  of  February  18,  1895,  prescribe  the  measures  of  a  perma- 
nent character  that  should  be  taken  against  epidemics ;  the  inspection  of  ves- 
sels; the  issuance  of  bills  of  health;  the  adoption  of  prophylactic  measures 
that  should  be  observed  before,  during  and  after  the  voyage ;  quarantine  and 


94  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

examinations;  sanitary  stations,  sanitary  tariffs,  and  the  duties  pertaining  to 
sanitary  authorities.  On  the  other  hand  the  government  enforces  as  a  na- 
tional law  the  Sanitary  Convention  of  Washington. 

With  regard  to  the  information  called  for  in  the  second  subject  on  the  pro- 
gram, we  beg  to  report  as  follows : 

Convention  of  Washington. 

Section  34  of  the  Convention  of  Washington  reads  thus : 

Packet  boats  shall  be  subjected  to  special  regulations,  to  be  established  by 
mutual  agreement  between  the  countries  in  interest. 

In  Chile  the  ships  of  the  Pacific  Steam  Navigation  Co.,  of  the  South 
American  Steamship  Co.,  and  of  the  Kosmos  Line  are  required  by  a  govern- 
mental decree  to  stop  at  Arica  to  be  inspected  by  the  Chief  of  the  Sanitary 
Station,  and  after  complying  with  this  requirement  then  allowed  to  proceed 
south. 

When  the  Sanitary  Station  is  informed  of  a  reappearance  of  plague  in  the 
ports  of  Peru,  in  Callao  to  the  south,  the  passengers  and  crew  are  inspected 
and  the  ship  disinfected  with  sulphur  gas. 

Article  35  of  the  Washington  Convention  reads  as   follows : 

Without  prejudice  to  the  right  which  governments  possess  to  agree  upon 
the  organization  of  common  sanitary  stations,  each  country  should  provide  at 
least  one  port  upon  each  of  its  seaboards,  with  an  organization  and  equipment 
sufficient  to   receive  a  vessel,   whatever  may  be  its   sanitary  condition. 

What  has  been  said  in  regard  to  the  Sanitary  Stations  shows  the  manner  in 
which  this  article  has  been  complied  with. 

With  reference  to  Article  36  of  the  Convention  of  Washington  we  may  say 
that  Chile  has  in  all  its  ports  a  sanitary  board  composed  of  the  maritime  gov- 
ernor, of  the  representative  of  the  Army  and  of  the  port  physician,  which 
boards  have  charge  of  the  enforcement  of  the  sanitary  measures  prescribed 
by  our  maritime  sanitary  legislation,  which  dates  from  1895. 

The  port  physician  inspects  the  crews  and  ships  arriving  at  the  port. 

The  sanitary  condition  of  the  population  of  the  port  is  generally  in  charge 
of  the  physicians  of  the  city. 

Conference   of  Mexico. 

Resolution  2.  In  the  Chamber  of  Deputies  there  is  under  discussion  a  bill 
codifying  the  sanitary  laws  and  measures  of  the  Republic,  amending  and 
amplifying  them. 

Resolution  3.  In  the  same  bill  vaccination  is  made  compulsory  to  all  in- 
habitants  of  the   Republic. 

Resolution  11.  In  Chile  no  immigrants  suffering  from  trachoma  or  beri- 
beri are  admitted. 

Resolution  12.  The  Sanitary  Code  which  will  soon  become  a  law  of  the 
Republic  the  sanitary  legislation  is  centralized. 

Resolution  13.  The  Government  railroad  have  a  sanitary  department  which 
is  in  charge  of  the  disinfection  of  cars,  berths,  cabins,  etc.,  inspects  the  per- 
sonnel, etc. 

Conference  of  Costa  Rica. 

I  Resolution.  The  Government  prepares  the  anti-rabic  vaccine  and  applies 
it  free  of  charge  in  the  Division  of  Seroterapy  of  the  Institute  of  Hygiene. 
The  Government  furnishes  free  transportation  to  the  capital  to  persons  who 
have  been  bitten  by  dogs  infected  or  suspected  of  rabies. 

II  Resolution.     Chile  is  carrying  on  its  work  of  sanitation  of  ports. 

Resolution  VIII.  In  Chile  there  are  several  private  associations  or  institu- 
tions engaged  in  the  fight  against  tuberculosis,  and  they  are  supported  and  sub- 
sidized by  the  Government. 

Said  institutions  also  educate  the  public  by  means  of  lectures,  publications, 
etc.,  regarding  the  manner  of  preventing  the  disease. 


FiFTH   INTERNATIONAL  SANITARY  CONFERENCE.  95 

Organization  and  Work  of  the  International  Sanitary  Information  Committees. 

The  International  Sanitary  Information  Committee  of  Chile  was  created  by 
Supreme  Decree  No.  579  of  May  30,  1908,  in  pursuance  of  the  resolutions 
adopted  by  the  Second  International  Conference  of  American  States,  held 
in  Mexico  in  1902,  by  the  First  International  Sanitary  Convention,  held  in 
Washington,  December,  1902,  and  by  the  Third  International  Conference  of 
American  States  held  in  Rio  Janeiro,  August,  1906,  which  latter,  by  para- 
graph b  of  Resolution  3,  requests  the  Governments  to  "establish  and  regulate 
in  each  American  country  a  Committee  composed  of  three  medical  or  sanitary 
authorities,  under  the  direction  of  the  International  Sanitary  Bureau  estab- 
lished at  Washington  as  an  International  Sanitary  Information  Committee 
with  power  to  meet  and  interchange  data  referring  to  public  health  and  for 
any  other  purpose  that  the  Conference  may  think  proper." 

In  the  Third  Sanitary  Conference  of  Mexico  it  was  resolved  to  establish  an 
International  Sanitary  Bureau  in  Montevideo  as  a  center  for  the  Information 
Committee  of  the  Argentine  Republic,  Bolivia,  Brazil,  Chile,  Uruguay  and 
Paraguay,  the  committees  of  the  other  Republics  reporting  to  the  Washington 
Bureau. 

The  Chilean  Committee  was  constituted  on  June  23,  1908,  and  through  the 
Department  of  Foreign  Affairs  its  organization  was  communicated  to  the  High 
Contracting  Parties. 

The  Government  of  the  Oriental  Republic  of  Uruguay  informed  the  Min- 
ister for  Foreign  Affairs  the  organization  of  the  Sanitary  Committee  of  Monte- 
video, under  date  of  May  11,  1911. 

The  Chilean  Committee  is  composed  of  Dr.  Ricardo  Davila  Boza,  director 
of  the  Institute  of  Hygiene,  Dr.  Lucio  Cordova,  ex-secretary  of  Supreme 
Council  of  Hygiene,  and  Dr.  Pedro  Lautaro  Ferrer,  Sanitary  Inspector  of  the 
Republic. 

With  regard  to  the  9th  subject  on  the  program,  we  may  say  that  in  the 
printed  reports  contain  the  demographic  statistics  for  the  principal  ports  and 
cities,  and  that  the  Bertillon  system  has  been  adopted  in  the  Republic. 


REPORT  OF  DOCTOR  FERNANDO  IGLESIAS,  DELEGATE 
FROM  COSTA  RICA. 

Mr.  President ;  Gentlemen :  When  the  Fourth  International  Sanitary  Con- 
ference of  the  American  Republics  adjourned  in  San  Jose  de  Costa  Rica,  several 
resolutions  were  adopted.  I  am  happy  to  state  that  the  Costa  Rican  Government 
has  complied  with  most  of  these  resolutions,  notwithstanding  the  difficulties 
which  have  arisen  due  to  the  earthquake  and  destruction  of  the  city  of  Cartago. 

The  Costa  Rican  Government,  ever  consistent  with  its  established  policies,  has 
given  particular  attention  to  hygiene,  by  the  enactment  of  important  measures  to 
prevent  the  propagation  of  contagious  diseases,  to  decrease  mortality,  and  the 
sanitation  of  the  ports  and  towns  of  the  republic.  The  following  sanitary  legis- 
lation has  been  enacted,  some  of  a  national  and  others  of  a  municipal  character. 

(1)  Surcharge  of  5%  on  customs  duties  on  goods  imported  by  Puntarenas, 
to  be  devoted  to  sanitation  of  said  port.     (August  17,  1910.) 

(2)  To  compel  physicians  to  report  to  the  authorities  and  the  Medical  Faculty, 
all  cases  of  infectious  diseases,  or  those  suspected  to  be  infectious,  coming  to 
their  knowledge  in  the  practice  of  their  profession.     (August  17,  1910.) 

(3)  To  invest  the  annual  sum  of  $25,000  (colones)  in  fighting  against  anky- 
lostomiasis.    (September  30,  1910.) 

(4)  Erection  of  buildings.     (August,  1910.) 

(5)  Introduction  of  potable  water  in  cities  and  towns,  taken  directly  from  the 
source. 

(6)  Decree  of  October  20,  1910,  on  sanitary  service,  creating  the  "personal  ob- 
servation card"  for  individuals  coming  into  the  country. 

(7)  Venereal  prophylaxis.     (Decree  of  November  25,  1910.) 

(8)  Closing  the  ports  to  steamers  coming  from  Venezuela,  Trinidad  and  Italy 
during  the  plague  and  cholera  epidemics. 

(9)  To  vest  upon  the  chiefs  of  Marine  Sanitation  and  Hygiene  the  authority 
of  police  officials. 

(10)  San  Jose  sewerage  and  drainage  of  a  majority  of  the  towns  in  the  re- 
public. 

Fulfilment  of  the  Resolutions  Adopted  by  the  Preceding  Four  Sanitary 

Conventions. 

On  March  4,  1911,  a  law  was  promulgated  on  the  sanitary  campaign  against 
ankylostomiasis,  whereby  the  annual  amount  of  25,000  colones  is  appropriated 
to  defray  the  expenses  of  the  physicians  engaged  in  the  fight,  distribution  of 
medicine  gratuitously,  etc.  By  this  law,  physicians  are  obliged  to  give  monthly 
lectures  in  each  town  on  general  questions  of  hygiene,  both  public  and  domestic, 
and  to  explain  the  importance  of  the  campaign  against  ankylostomiasis,  pointing 
out  the  means  to  resist  and  prevent  the  disease. 

Gastro-intestinal  parasitic  diseases  in  Costa  Rica  have  two  fields ;  among 
children  under  five  years  of  age,  their  mortality  reaching  the  alarming  rate  of 
52.3%,  and  among  those  afflicted  with  ankylostomiasis.  Dysentery  is  another 
disease  which  causes  a  large  number  of  victims  in  Costa  Rica.  In  view  of  these 
facts,  and  of  the  provisions  of  Sec.  1,  Art.  3,  of  the  resolutions  of  the  Fourth 
Sanitary  Conference,  the  Government  and  the  Municipalities  have  directed  all 
their  efforts  to  provide  all  cities  and  towns  with  sanitary  water  service  through 
a  system  of  pipes,  directly  from  the  headwarters  or  source  of  the  streams. 

The  sanitation,  hygiene  and  vigilance  of  our  ports  has  had  special  attention, 
and  the  country  has  had  no  epidemics  of  a  general  or  alarming  character  to 
fight  against.  During  the  month  of  July  there  was  a  case  of  yellow  fever  in 
Siquirres,  and  the  Government,  the  Medical  Faculty  and  the  U.  S.  Fruit  Com- 
pany, all  took  energetic  and  efficient  means  to  fight  against  the  spread  of  the 
disease.  This  was  accomplished  as  well  as  the  complete  sanitation  of  the  zone, 
with  excellent  and  positive  results. 


98  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

By  resolutions  of  May  20,  September  5  and  November  20,  1910,  the  ports  of 
the  country  were  closed  to  all  vessels  from  the  island  of  Trinidad,  and  from 
Venezuelan  and  Italian  ports,  and  other  suspected  localities.  The  quarantine 
service  was  performed  by  the  Sanitary  Police,  and  immigrants  were  submitted 
to  periodical  observation.  During  the  previous  year  15  patients  were  sent  to 
the  quarantine  station  on  the  Uvita  island,  and  of  these  2  were  cases  of  typhoid 
fever  and  7  of  malaria.  The  quarantine  station  has  been  thoroughly  repaired. 
A  special  department  has  been  built  for  fumigation,  and  four  rooms  for  isola- 
tion; all  doors  and  windows  have  been  protected  by  wire  screens,  and  a  large 
covered  water  tank  was  also  built. 

In  Limon  death  rate  among  children  is  about  one-third  of  the  general  mor- 
tality. Malaria  is  prevalent,  but  has  decreased,  due  to  the  use  of  petroleum. 
All  privies  have  been  closed  up,  or  connected  with  the  sewers;  67  back  yards 
have  been  filled  and  all  cess  pools  and  swamps  treated  with  petroleum. 

On  October  29,  1910,  a  decree  (No.  5)  was  issued  creating  the  "personal  ob- 
servation cards."  By  the  provisions  of  this  decree,  every  person  arriving  in  the 
country  is  under  obligation  to  report  every  day,  during  one  week,  to  the  town 
doctor,  for  examination;  every  other  day,  the  second  week,  and  every  third  day, 
the  third  week.  At  present  there  are  under  construction  in  Limon  the  customs 
warehouses,  built  of  iron  and  cement,  rat  proof,  as  recommended  by  the  Fourth 
Sanitary  Conference. 

The  report  submitted  by  the  Costa  Rican  Delegation  to  the  Fourth  Sanitary 
Conference  shows  that  deaths  due  to  tuberculosis  increase  every  year.  Un- 
fortunately, this  increase  still  continues,  and  Dr.  Cespedes  in  his  last  report 
states  "tuberculosis  has  had  a  remarkable  increase,  mainly  among  the  colored 
people." 

There  has  been  no  epidemic  at  the  port  of  Puntarenas.  Malaria  has  almost 
disappeared,  due  to  cleanliness  and  removal  of  all  stagnant  waters.  The  Marine 
Sanitary  Service  has  always  taken  the  precaution  of  examining  every  passenger 
entering  the  country. 

The  Bacteriological  Laboratory  has  given  excellent  results.  During  the  past 
year  4,407  analyses  were  made. 

Death  rate  among  children  in  the  provinces  was  as  follows  in  1910 :  San 
Jose,  1,609;  Alajuela,  1,101;  Cartago,  1,040;  Heredia,  463;  Guanacaste,  393; 
Puntarenas,  243 ;  Limon,  241 ;  a  total  of  5,090. 

The  causes  of  mortality  among  children,  embraced  in  the  principal  groups, 
according  to  the  international  classification,  are  as  follows : 

1909.  1910.       Difference. 

I.     General  diseases   557  408  —149 

II.     Diseases  of  the  nervous  system  or  other 

organs 838 

III.  Diseases  of  the  respiratory  organs 497 

IV.  Diseases  of  the  digestive  organs 1,895 

V.     Other  diseases  1,376 


TUBERCULOSIS. 

Provinces.  1909. 

San  Jose    104 

Limon 47 

Heredia 41 

Cartago 26 

Alaj  uela 29 

Puntarenas 18 

Guanacaste 22 


861 

23 

397 

—100 

2,142 

247 

1,333 

—43 

Cantons. 

San   Jose    82 

Limon 47 


19 IO. 

Difference. 

74 

—30 

51 

4 

49 

8 

33 

7 

30 

1 

27 

9 

24 

2 

52 

—30 

51 

1 

no. 

Difference. 

20 

—1 

18 

1 

IS 

8 

12 

1 

10 

3 

41 

—19 

39 

9 

13 

3 

10 

4 

9 

—7 

9 

—1 

FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  99 

Cantons  1909. 

Heredia 21 

Cartago 17 

Esparta 7 

Puntarenas 11 

Barba 7 

Cities. 

San  Jose  60 

Limon 30 

Heredia 10 

Esparta 6 

Puntarenas 16 

Liberia 10 

The  number  of  fatal  cases  of  tuberculosis  in  the  entire  republic  was  288. 

MEASLES  AND  SCARLET  FEVER. 

There  were  no  cases  of  measles,  and  but  3  of  scarlet  fever. 

TYPHOID  FEVER. 

Provinces.  1909. 

San  Jose 48 

Alajuela 15 

Cartago 11 

Heredia 6 

Guanacaste 2 

Limon 1 

Puntarenas 0 

Cantons. 

San  Jose  31 

Alajuela 12 

Heredia 3 

Cities. 

San  Jose 14 

Heredia 1 

In  the  entire  country  there  were  77  deaths  from  typhoid  fever,  or  an  increase 
of  6  cases  over  1909. 

CHOLERA  INFANTUM. 

Provinces.  1909. 

San  Jose    159 

Alajuela 114 

Cartago 56 

Heredia 31 

Limon 1 

Guanacaste 

Puntarenas 2 

Cantons. 

San  Jose 108 

Alajuela 16 

Cartago 25 

Grecia 44 

Alvarado 10 

Atenas 11 

Jimenez 14 


1910. 

Difference. 

33 

—15 

26 

11 

8 

—3 

7 

1 

2 

.  . 

1 

0 

0 

23 

—8 

22 

10 

6 

3 

13 

—1 

5 

4 

1910. 

Difference. 

227 

68 

114 

111 

55 

50 

19 

9 

8 

4 

4 

2 

139 

31 

41 

25 

38 

13 

27 

—17 

22 

12 

20 

9 

20 

6 

110. 

Difference, 

71 

40 

9 

2 

100  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

Cities.  1909. 

San  Jose  31 

Grecia 7 

As  shown  by  the  preceding  figures  cholera  infantum  claimed  in  1910  twice  as 
many  victims  as  in  1909,  in  the  city  of  San  Jose. 


Sanitary  Department. 

The  Sanitary  Department  of  San  Jose  has  rendered  great  and  important  serv- 
ices. During  1910,  910  water  closets  were  built  or  improved,  191  drainage  pipes 
or  sinks  were  built,  38  cess  pools  and  84  swamps  were  filled  in  or  reclaimed,  be- 
sides all  the  work  in  connection  with  the  sewers. 

The  "Clayton"  machine  is  used  in  San  Jose  for  disinfection,  particularly  in 
cases  of  diphtheria,  malignant  dysentery  and  tuberculosis.  In  the  disinfection 
of  sewers,  sinks,  etc.,  60,000  kilograms  of  "kreso"  were  consumed  in  1910. 


REPORT  OF  DR.  HUGO  ROBERTS,  DELEGATE  FROM 

CUBA. 

Mr.  President,  Messrs.  Delegates:  In  accordance  with  the  Program  adopted 
for  this  Conference,  I  have  the  honor  to  report  upon  our  sanitary  legislation 
passed  since  the  last  Conference,  that  is  to  say,  since  the  latter  part  of  1909. 
I  must  call  your  attention  to  the  fact  that  there  is  in  Cuba  a  Department  of 
Health  and  Beneficence.  The  importance  given  to  sanitary  matters  in  my 
country,  made  us  feel  the  necessity  of  that  organization,  and  since  its  creation, 
everything  concerning  so  important  a  branch  is  entrusted  to  that  Department^ 
not  only  as  regards  domestic  sanitation,  but  also  concerning  foreign  relations,' 
that  is  to  say,  quarantine  and  immigration. 

For  the  regulation  of  interior  sanitation,  there  are  in  force  the  Sanitary 
Ordinances  promulgated  in  1907  and  reported  to  a  previous  Conference.  For 
this  reason  I  shall  confine  myself  to  enumerating  only  the  amendments  thereto. 

These  amendments  refer  to  foods  and  beverages;  construction  of  buildings; 
ventilation,  drainage  and  sanitary  works;  hotels,  lodging  houses,  cafes,  restau- 
rants, etc.,  schools,  colleges,  academies,  seminaries,  and  other  educational  in- 
stitutions; classification  of  obnoxious,  sanitary  and  uncomfortable  factories 
and  establishments;  hospital,  infirmaries,,  lazarettos,  and  clinics. 

New  chapters  have  been  added  on  animal  sanitary  police;  professions  (spe- 
cially dental  surgery)  ;  wet  nurses  and  ophthalmia  neonatorum. 

Sanitary  laws  being  completely  uniform  throughout  the  whole  country,  it  was 
found  necessary  to  issue  instructions  to  the  84  local  health  chiefs  of  the 
various  districts,  as  to  the  interpretation  of  the  law  and  as  to  the  adminis- 
trative procedure  to  be  followed  in  each  locality.  For  that  purpose  official 
instructions  were  printed,  regarding  not  only  the  legal  functions  of  the  chiefs 
and  personnel  under  them,  but  also  their  relations  with  the  General  Bureau 
and   the  Department. 

As  regards  quarantine  service  or  foreign  sanitation,  there  are  in  force  in 
Cuba  the  resolutions  adopted  by  the  Conference  of  Washington,  Mexico  and 
San  Jose  de  Costa  Rica.  I  do  not  speak  now  of  the  manner  in  which  the 
resolutions  of  the  named  conference  have  been  complied  with  because  I  will 
do  so  when  reporting  upon  the  second  subject  on  the  program.  But  I  will 
take  the  liberty  to  state  that  in  the  opinion  of  the  sanitary  authorities  of 
Cuba,  the  Washington  Convention  is  deficient  in  some  respects,  particularly 
in  regard  to  cholera  and  to  the  classification  of  vessels.  Thus  it  seems  neces- 
sary to  revise  the  resolutions  passed  by  that  Conference.  To  this  end  I  have 
confidential  instructions  from  our  Director  of  Health,  Dr.  Juan  Guiteras.  In 
this  connection,  I  must  point  out  to  the  fact  that  such  necessity  has  been  felt 
not  only  in  Cuba,  but  also  in  several  European  nations,  because  in  the 
Sanitary  Conference  that  is  about  to  be  held  in  Paris  they  are  going  to  revise 
the  conventions  signed  in  that  city  in  1903  and  from  which  the  Washington 
Convention   has  been   copied. 

I  make  these  statements  submitting  them  to  the  Conference  should  it  deem  it 
convenient  to  take  them  into  consideration.  I  must  state  also  that  in  order 
to  prevent  the  introduction  in  Cuba  of  any  person  carrying  cholera  bacilli,  from 
European  countries  with  which  we  maintain  frequent  relations,  we  resort  to 
the  bacteriological  examination  by  means  of  the  rectal  catheter,  and  only  when 
a  negative  result  has  been  obtained  is  the  free  entry  granted. 

If  it  is  important  to  fight  the  diseases  that  ravage  humanity,  it  is  no  less 
important  to  study  and  apply  all  means  advised  by  science  with  regard  to 
reproduction,  conservation  and  improvement  of  humankind,  that  is  to  say 
Homiculture,  a  science  recently  constituted  and  unified,  and  which  has  for 
its  object,  among  other  things,  the  prevention  of  morbinativity  and  mortinativ- 
ity,  infantile  mortality  and  morbility  and  puerperal  diseases.  The  Executive 
has  requested  from  the  legislature  an  appropriation  for  the  establishment  of  the 
"Hernandez-Pinard  Palace  of  Homiculture,"  which,  as  our  Secretary  of 
Health  puts  it,  "will  serve  not  only  in  the  case  of  women  and  children,  but 
also  as  a  school  for  mothers  wherein  women  shall  be  taught  in  a  practical 
manner  the  rules  and  cares  that  they  should  follow  for  the  preservation  of 
their  health  and  that  of  their  children." 


102  FIFTH   INTERNATIONAL   SANITARY   CONFERENCE. 

Upon  the  principles  of  homiculture,  our  Health  Department  is  about  to 
undertake  a  special  campaign  against  morbinativity  and  mortinativity,  and  in- 
fantile morbidity,  for  which  purpose,  Dr.  Matias  Duque,  former  Sercetary  of 
Health,  created  a  division  of  pediatrics  in  connection  with  the  Bureau  of  In- 
vestigations and  Research  of  the  Department.  Drs.  Ramos  and  Hernandez, 
the  originators  of  the  idea  in  Cuba,  have  done  considerable  work  on  the  sub- 
ject, but  it  being  too  lengthy  I  shall  abstain  from  speaking  thereof.  The 
Delegates,  however,  will  find  all  information  thereon  in  the  reports  made 
by  those  scientists.  The  importance  of  the  work  thus  initiated  is  self-evident. 
Its  ends  are  the  increase  of  population  and  the  improvements  of  the  race. 

For  the  purpose  of  bettering  the  conditions  under  which  laborers  live,  our 
Government  has  built  and  is  building  "houses  for  laborers."  These  houses 
are  provided  with  adequate  conveniences,  and  the  laborers  may  acquire  title 
to  them  by  the  payment  of  a  small  monthly  payment. 

We  are  now  free  from  quarantine  diseases.  Smallpox  has  been  eradicated 
from  our  territory,  where  it  has  not  appeared  for  the  last  ten  years.  As  a 
whole,  the  sanitary  condition  of  the  Republic  is  excellent,  as  is  shown  by 
our  death  rate,  which  was  13.03  per  1,000  in  1909  and  15.57  in  1910. 

With  reference  to  the  second  and  third  subjects  of  the  Program,  I  shall  now 
enumerate  what  has  been  done  by  my  Government  in  compliance  with  the 
resolutions  passed  by  the  Fourth  Sanitary  Conference,  held  in  Costa  Rica  (see 
the  text  of  said  resolutions  in  the  Appendix,  Translations  of  the  Fourth  Inter- 
national  Sanitary  Conference,  page   105). 

I  Resolution. — The  Department  of  Health  is  actively  engaged  in  fighting 
these  diseases.  Bilharziosis,  in  so  far  as  we  know,  and  exanthematic  typhus, 
positively,  do  not  exist  in  the  Republic.  Leprosy  and  typhus  are  quarantine 
diseases. 

II  Resolution. — Thanks  to  the  centralization  of  the  sanitary  services  of  the 
Republic,  there  is  a  great  deal  of  efficiency  in  enforcing  the  measures  recom- 
mended by  this  Resolution,  excepting  plague,  which  disease  has  never  threatened 
us  directly.  Rigid  inspection  is  kept  over  suspected  arrivals,  which  are  duly 
disinfected.  Educational  propaganda  has  been  carried  out  on  the  extermination 
of  rats,  and  at  the  Las  Animas  Hospital  we  are  carrying  on  experimental 
studies  on  the  extermination   of  rats  and  fleas. 

III  Resolution. — The  recommendations  made  in  this  resolution  are  complied 
with  by  the  Government  of  Cuba  and  it  may  be  said  that  they  are  embodied  in 
our  sanitary  policy. 

IV  Resolution. — In  order  literally  to  comply  with  this  resolution,  it  would 
be  necessary  that  all  nations  should  come  to  an  agreement.  In  Cuba  it  is 
carried  out  to  a  certain  extent,  as  vessels  are  very  frequently  treated  in  order 
to  rid  them  of  rats,  specially  when  they  come  from  places  infected  or  sus- 
pected of  plague. 

V  Resolution. — Cholera,  small-pox  and  exanthematic  typhus  do  not  exist 
in  Cuba.  As  regards  other  contagious  or  transmissible  diseases,  such  as  measles, 
scarlet  fever,  and  diphtheria,  etc.,  no  person  suffering  therefrom  is  allowed  to 
embark,  because  our  Sanitary  Ordinances  provide  that  such  patients  be  con- 
fined in  special  hospitals  for  infectious  diseases,  if  they  are  not  properly  isolated. 

VI  Resolution. — This  interpretation  has  always  been  sustained  by  the  Cuban 
Government. 

VII  Resolution. — This  is  the  sixth  subject  on  the  program,  and  I  shall, 
therefore,  speak  of  it  at  its  proper  place. 

VIII  Resolution. — This  has  been  complied  with  in  my  country,  and  I  shall 
take  it  up  at  the  point  where  I  report  upon  the  fifth  subject  on  the  program. 

IX  Resolution. — These  models  of  sanitary  documents  were  submitted  by  the 
Cuban  Delegation  to  the  Fourth  Conference  and  were  adopted  by  the  Govern- 
ment immediately  afterwards. 

X  Resolution. — In  compliance  with  the  resolution  my  Government  has  ap- 
pointed me  as  its  Delegate  to  the  Third  and  Fourth  Conferences  held  in  Mexico 
and  Costa  Rica,  respectively. 

XI  Resolution. — It  seems  that  the  Information  Bureau  of  Montevideo  has 
not  as  yet  been  duly  organized. 

XII  Resolution. — The  Government  of  Cuba  strives  to  render  the  medical 
profession  most  efficient  for  fighting  any  diseases  liable  to  cause  serious  dis- 
turbances in  public  health,  and  for  this  purpose,  there  have  recently  been  de- 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  103 

livered  in  the  Las  Animas  Hospital  free  lectures  on  bacteriology  of  cholera  and 
other  diseases,  all  physicians  having  been  invited  to  attend. 

XIII  Resolution. — We  have  in  Cuba  a  great  number  of  public  and  private 
laboratories  where  the  work  referred  to  in  the  resolution  is  carried  on. 

The  fifth  subject  on  the  program  requires  a  report  on  the  sanitary  progress 
of  the  principal  cities,  in  each  country. 

Havana,  our  capital,  is  now  undergoing  a  great  transformation  which  will 
render  better  still  its  sanitary  conditions  and  will  embellish  it  remarkably. 
During  the  last  two  years  the  sewer  and  paving  works  have  been  going  on, 
although  at  present  not  very  rapidly  in  order  not  to  interrupt  public  traffic. 
In  spite  of  the  large  quantities  of  earth  that  have  been  removed  not  one  single 
case  of  typhoid  fever  has  occurred. 

Large  extension  works  are  being  carried  on  in  connection  with  our  magnifi- 
cent aqueduct  of  the  Alvear  Canal,  in  order  to  increase  the  water  supply  and 
carry  it  to  every  section  of  the  capital.  The  works  for  dredging,  draining  and 
filling  the  port  has  also  been  started,  and  likewise  the  construction  of  splendid 
steel  and  cement  wharves,  which  will  facilitate  the  extermination  of  rats. 

Cienfeugos,  the  second  largest  city  in  the  Republic,  is  also  nndergoing  im- 
portant changes.  Sewer  and  paving  works  are  now  under  construction.  There 
is  a  fairly  good  water  supply  which  is  being  improved. 

We  have  under  consideration  the  building  of  an  immigration  station,  and  the 
enlarging  of  the  present  floating  quarantine  station  turning  it  into  a  land  sta- 
tion, to  be  provided  with  every  necessity  to  meet  the  increased  traffic  inci- 
dental to  the  opening  of  the  Panama  Canal. 

In  Nipe,  a  town  on  the  northern  coast  and  possessing  the  largest  bay  of  the 
Republic,  we  are  planning  to  establish  a  quarantine  and  immigration  station. 

In  Santiago,  the  capital  of  Oriente  Province,  we  have  rebuilt  the  Cayo  Duan 
quarantine  station,  and  is  soon  to  be  completed,  at  a  total  coast  between  $65,000 
and  $70,000.  An  immigration  station  is  also  going  to  be  built  very  soon.  The 
city  has  two  aqueducts  and  another  is  being  constructed.  The  sewer  and  pav- 
ing works  are  about  to  be  finished. 

The  Cuban  Government,  fully  cognizant  of  the  influence  exercised  by  social 
hygiene  on  public  health,  as  well  as  of  the  decisive  importance  of  the  success 
that  may  be  accomplished  in  fighting  the  epidemics  that  ravage  humanity,  has 
strived  by  all  possible  means  to  keep  the  public  posted  on  the  hygienic  pre- 
cautions that  should  be  observed  in  order  to  ward  off  contagious  diseases, 
specially  against  those  which,  on  account  of  their  epidemic  nature  or  the 
number  of  victims  that  they  may  cause,  should  be  more  directly  fought. 

Our  Sanitary  Ordinances  contain  exhaustive  instructions  as  to  the  manner 
of  preventing  such  diseases,  but  as  they  can  not  be  properly  understood  by  the 
masses  of  the  population,  different  pamphlets  under  the  general  title  of  "Popu- 
lar Instructions"  have  been  issued  and  widely  distributed.  Those  recently 
printed  relate  to  rabies,  tuberculosis,  cholera,  etc. 

The  "Popular  Lessons  on  Tuberculosis"  were  awarded  a  prize  by  the  Tuber- 
culosis Congress  recently  held  in  Barcelona,  Spain.  "Popular  Instructions  on 
Asiatic  Cholera"  have  also  been  printed  and  distributed  to  prepare  our  public 
in  case  that  disease  now  prevalent  in  some  European  ports,  should  invade  our 
country. 

With  regard  to  venereal  diseases,  I  have  to  say  that  prostitution  is  regu- 
lated in  Cuba,  it  being  considered  as  a  necessary  evil.  Therefore,  women  thus 
engaged  are  subject  to  special  regulations,  which  compel  them  to  report  at 
Division  of  Special  Hygiene  in  order  to  undergo  a  periodic  medical  examina- 
tion ;  those  found  suffering  of  such  diseases  are  confined  in  a  special  clinic 
exclusively  devoted  to  their  treatment.  These  regulations  also  refer  to  the 
places  where  prostitutes  may  live,  designating  the  districts  set  aside  for  the 
purpose ;  under  them  prostitutes  are  not  allowed  to  occupy  conspicuous  places 
in  theaters,  nor  to  drive  in  open  carriages,  etc. 

Bearing  in  mind  the  important  role  played  by  man  in  the  transmission  of 
venereal  diseases,  there  has  been  established,  as  an  annex  of  the  Division  of 
Special  Hygiene,  a  dispensary  for  men,  where  those  resorting  to  it  voluntarily 
are  properly  treated.     They  are  mostly  laborers. 

The  seventh  subject  of  the  program  refers  to  the  "Criterion  as  to  what 
constitutes  immunity  from  yellow  fever."  For  practical  purposes  of  quarantine 
against  yellow  fever,  those  that  may  be  considered  as  immune  from  yellow 
fever,  are : 


104  FIFTH    INTERNATIONAL  SANITARY   CONFERENCE. 

First.  Individuals  proving-  by  means  of  official  documents  to  the  satisfaction 
of  the  authorities  in  the  port  of  arrival,  that  they  have  suffered  from  yellow 
fever. 

Second.  Those  who  have  resided  for  a  period  of  ten  years  in  a  district  where 
there  has  broken  out  yearly  a  focus  of  the  disease  during  that  period. 

Considering  that  the  ports  and  cities  of  the  first  and  second  class  in  the 
Island  of  Cuba  were  yellow  fever  focii  up  to  September,  1901,  those  who  have 
resided  in  said  ports  and  cities  for  a  period  of  not  less  than  ten  years  prior 
to  that  date,  are  therefore  to  be  considered  as  immune  from  the  disease. 

The  adoption  of  systematic  measures  for  the  extermination  of  rats  on  board 
ships,  is  of  vital  importance  since  the  discovery  of  the  active  role  played  by 
these  rodents  in  the  transmission  of  plague. 

In  Cuba,  all  ships  arriving  from  ports  where  there  has  been  plague  are  sub- 
jected "deratization,"  but  it  can  be  stated  that  such  "deratization"  has  not  been 
efficient  in  all  cases,  because  in  the  greater  number  of  instances  we  have  to  deal 
with  ships  completely  loaded  with  merchandise  which  only  make  short  stops  in 
Cuba  in  order  to  unload  a  small  part  of  their  cargo.  For  this  reason  it  can 
not  be  always  guaranteed  that  the  death-dealing  gases  reach  every  section  of 
the  ship.  In  all  nations  where  ships  are  chartered  they  require  that  for  the 
protection  of  passengers  every  vessel  should  observe  certain  conditions,  and 
be  provided  with  the  necessary  means  to  meet  any  emergency,  likewise,  every 
vessel  is  subject  to  periodic  inspection.  Now,  then,  the  elimination  of  the 
presence  of  plague  rats  on  board  should  be  included  among  the  conditions  re- 
quired of  all  ships  to  protect  the  health  of  those  on  board  and  prevent  the 
spread  of  plague.  In  view  of  the  preceding,  I  have  the  honor  to  move  the 
following  be  adopted : 

"Every  vessel  should  be  provided,  together  with  the  papers  issued  by  the 
proper  authorities,  with  a  certificate  also  issued  by  a  proper  authority,  to  the 
effect  that  it  has  been  totally  ridden  of  rats  while  in  ballast,  for  a  period  not 
exceeding  six  months. 

"This  document  shall  be  indispensable,  like  all  other  papers  with  which  a 
ship  must  be  provided  in  order  to  engage  in  navigation. 

"Nations  participating  in  this  conference  shall  allow  a  period  not  exceeding 
six  months  to  vessels  of  their  respective  flags  to  comply  the  conditions  wherein 
prescribed." 

With  respect  to  ships  arriving  from  any  locality  infected  with  yellow  fever, 
the  Washington  Convention  specifies  the  treatment  to  which  they  shall  be  sub- 
jected in  order  to  eliminate  mosquitoes.  Vessels  with  flies  on  board  may, 
when  necessary  be  subjected  to  the  same  measures,  although  these  insects  should 
not  exist  in  a  ship  where  cleanliness  prevails  regularly. 

Our  sanitary  ordinances  contain  a  chapter  dealing  exclusively  on  hygiene  of 
railroads,  street  railways  and  omnibuses,  because  of  the  large  number  of  per- 
sons traveling  on  such  vehicles. 

The  principal  requirements  prescribed  by  said  chapter  are  those  referring 
to  cleanliness  in  the  transportation  of  passengers. 

The  last  and  ninth  subject  on  the  program  refers  to  "monthly  and  yearly 
statistics  of  morbidity  and  mortality  in  the  principal  ports  and  cities;  infor- 
mation in  regard  to  the  adoption  of  Bertillon's  nomenclature." 

Cuba  can  be  proud  of  its  death  rate,  which  is  one  of  the  lowest  in  the  world. 
In  order  to  give  you  an  idea  of  this  interesting  subject,  I  shall  quote  some  extracts 
from  the  reports  prepared  by  the  Chief  Statistician  of  the  Health  Department, 
for  the  years  1909  and  1910. 

A  resume  of  the  demographic-sanitary  statistics  for  1909  shows  that  there 
were  recorded  during  the  year  70,167  births,  28,832  deaths,  and  12,552  marriages, 
which  show  an  increase  of  4,800,  471,  and  394,  respectively,  over  1908. 

As  to  the  movement  of  incoming  and  outgoing  passengers  at  all  ports  of  the 
Republic— according  to  statistics  furnished  by  the  Department  of  Finance- 
there  were  67,322  arrivals  and  57,505  departures,  or  an  increase  in  population  of 
9  817  persons.  Comparing  these  figures  with  those  of  the  preceding  year,  it  is 
seen  that,  although  there  was  an  increase  of  3,506  in  the  arrivals,  the  departures 
increased  by  3,852,  so  that  in  the  net  gain  there  was  a  decrease  of  346 

The  total  population  of  the  Republic  has  been  duly  estimated  at  2,199,859 
inhabitants  on  December  31,  which,  in  comparison  with  the  census  of  190/ 
shows  an  increase  of  150,879  within  the  short  period  of  two  years.     Examining 


FIFTH    INTERNATIONAL   SANITARY   CONFERENCE.  105 

the  rates  given  by  each  the  mentioned  demographic  factors,  we  have  that  births 
are  represented  by  135.10;  deaths,  13.03,  and  marriages,  by  51.32;  which,  com- 
pared with  those  for  the  preceding  year  show  the  following  increases:  9.57; 
0.29,    and    1.66;    respectively. 

I  beg  to  call  your  attention  particularly  to  the  low  total  death  rate  of  the 
Republic,  13.03,  which  continues  placing  on  a  very  high  level  among  the  coun- 
tries publishing  demographic  statistics,  and  which  render  Cuba  as  one  of  the 
most  healthful  countries  in  the  whole  world.  On  the  other  hand,  these  figures 
serve  to  show  the  fallacy  of  the  assertion  as  to  the  unhealthiness  of  the  tropical 
countries.  The  sanitary  state  of  a  country  is  measured,  not  by  its  climatic  con- 
ditions, but  the  application  of  the  measures  adopted  in  accordance  with  scien- 
tific rules.  Nevertheless,  in  spite  of  these  gratifying  figures,  when  analyzing 
the  causes  that  have  produced  them  we  can  not  but  lament  some  hundreds  of 
deaths  which  could  have  been  avoided  if  those  scientific  rules  had  only  reached 
the  popular  masses,  through  education. 

The  daily  average  of  deaths  during  1909  was  78.99,  as  against  77.49  in  1908. 
Examining  them   with    those   of  the    preceding  year,   we   have   the    following: 

Increase — Disease  of  circulatory  system,  9.40  against  9.31 ;  bronchitis,  bronco- 
pneumonia,  and  neuromia,  6.29  against  5.92;  rickets,  3.46  against  3.13;  cancer, 
2.69  against  2.46;  meningitis,  2.70  against  2.11;  malaria,  2.04  against  1.99; 
Bright's  disease,  1.76  against  1.67;  senility,  1.74  against  1.53;  cirrhosis  of  the 
liver,  0.88  against  0.75;  grippe.  0.85  against  0.63;  measles,  0.30  against  0.17. 

Decrease:  Enteritis  (children  under  one  year),  9.44  against  9.52;  tuber- 
culosis, 8.89  against  9.61;  pulmonar  tuberculosis,  7.88  against  8.53;  tuberculosis 
in  other  organs  and  tissues,  1.01  against  1.08;  tetanus  neonatorum,  1.91  against 
2.15;  typhoid  fever,  0.69  against  0.86;  whooping-cough,  0.40  against  0.95. 

Among  the  deaths  due  to  non-pathological  causes,  but  to  accidental  causes, 
I  must  mention  those  produced  by  the  sinking  of  the  S.  S.  Nicolas  Castanos; 
those  due  to  lightning  or  electrical  currents,  and  those  caused  by  typhoons  and 
storms,  specially  in  the  Eastern  region  of  the  Island. 

With  regard  to  the  year  1910,  there  were  recorded  in  the  Republic  13,446 
marriages,  76,706  births,  3,243  still-births  and  children  who  died  before  being 
24  hours  old,  and  33,844.  As  compared  with  1909,  there  is  an  increase  of  894 
marriages,  6,539  births,  and  5,012  deaths,  and  a  decrease  of  147  still-births. 

With  respect  to  the  movement  of  passengers  arrived  and  departed,  there  were 
in  1910  77,744  arrivals,  and  57,924  departures,  having  a  balance  in  favor  of  the 
population  of  19,820.  Comparing  those  figures  with  1909  we  have  an  increase 
of  10,422  in  arrivals  and  a  decrease  of  419  in  departures. 

The  population  of  the  Republic  for  June  30,  1910,  has  been  estimated  at 
2,161.671  inhabitants,  according  to  the  census  taken  by  the  Department  of  the 
Interior.  These  figures  show  an  increase  of  38,188  over  December  of  1909. 
The  mortality  in  1910  shows  a  coefficient  of  15.57,  quite  higher  than  that  of  1909, 
which  was  only  13.03.  (For  an  explanation  of  the  causes  of  death  and  detailed 
statistics,  see  Spanish  Edition  of  the  Conference.) 


REPORT  OF  DR.  LUIS  FELIPE  CORNEJO  Y  G6MEZ, 
DELEGATE  FROM  ECUADOR. 

In  the  first  place  I  want  to  express  the  deep  regret  of  the  Government  of 
Ecuador  at  having  been  prevented  by  unforseen  causes  at  a  last  hour  from 
attending  the  Fourth  Sanitary  Conference,  held  in  the  capital  of  Costa  Rica. 

Our  geographical  position  in  the  very  heart  of  the  tropics,  has  been  the 
principal  source  of  the  endemic  diseases  that  have  hindered  the  growth  of 
our  population,  and  for  this  reason  there  has  been  aroused  in  our  public  a 
strong  sentiment  for  the  sanitation  of  our  cities,  to  which  end  the  Congress  of 
the  Republic  has  just  issued  a  law  approving  the  gigantic  project  for  the  sani- 
tation of  Guyaquil,  which  includes :  the  sewerage  of  the  city  and  the  paving 
of  its  streets,  water  supply,  extension  of  the  embankment,  and  other  im- 
portant improvements,  all  of  which  constitute  a  colossal  work  in  the  execution 
of  which  the  enormous  sum  of  50,000,000  francs  will  be  invested.  A  respon- 
sible French  firm  has  taken  charge  of  this  work,  which  will  insure  the  sanita- 
tion of  the  principal  port  of  the  Republic. 

The  sanitary  legislation  of  Ecuador  is  of  two  kinds:  (1)  sanitary  laws 
and  regulations,  and  (2)  municipal  ordinances  on  hygiene.  The  enforcement 
of  the  former  is  in  charge  of  the  Public  Health  Service,  and  that  of  the  lat- 
ter, of  the  various  municipal  police  departments. 

The  first  sanitary  institution  we  had  in  Ecuador  were  the  health  boards, 
where  organization  was  very  heterogeneous,  while  on  the  other  hand  their 
scope  was  limited  almost  exclusively  to  the  defense  of  ports  against  quaran- 
tinable  diseases. 

The  aparition  of  plague  in  Guayaquil  in  1908  initiated  a  new  era  in  sanitary 
measures,  and  by  executive  decree  of  the  same  year  the  Special  Sanitation 
Commission  was  created,  which  was  later  replaced  by  the  Public  Health  Serv- 
ice by  law  of  November  3,  1908,  enacted  by  the  Congress  of  the  Republic. 

The  Public  Health  Service  is  constituted  by  a  General  Bureau  located  in 
Guayaquil  and  several  sub-bureaus  in  the  various  provinces,  under  the  gen- 
eral Bureau  for  the  purposes  of  administration,  and  under  the  Cantonal 
boards,   for  purposes  of  financial  management. 

The  General  Bureau  has  issued  the  following  sanitary  regulations:  (1) 
Campaign  against  small-pox;  (2)  making  vaccination  compulsory  in  the  city 
of  Guayaquil  (this  has  been  superceded  by  a  law  of  Congress  making  vaccina- 
tion compulsory  throughout  the  whole  country)  ;  (3)  compulsory  report  by 
physicians  of  all  infectious  diseases;  (4)  campaign  against  mosquitoes;  (5) 
isolation  of  confirmed  and  suspected  yellow  fever  cases;  (6)  restrictions  on 
the  removal  of  infectious  cases  from  one  place  to  another;  (7)  restrictions  on 
attendance  of  infectious  patients  in  private,  which  is  only  allowed  in  excep- 
tional cases;  (8)  special  provisions  for  the  removal  of  yellow  fever  or  plague 
patients  to  Guayaquil  from  neighboring  points;  (9)  restrictions  on  the  burial 
of  persons  dying  of  plague  or  small-pox;  etc.,  etc. 

The  maritime  sanitary  regulations  are  based  upon  the  stipulations  of  the 
Washington  Sanitary  Convention. 

Other  hygienic  matters,  such  as  the  inspection  of  markets,  groceries,  etc., 
street  cleaning,  removal  and  cremation  of  garbage,  etc.,  etc.,  are  entrusted  to 
the  municipal  governments.  On  the  other  hand,  the  police  departments  render 
their  valuable  cooperation  in  helping  the  sanitary  authorities  enforce  the  sani- 
tary laws  and  regulations. 

Among  other  bills  of  a  sanitary  nature  now  pending  in  Congress,  is  one  ad- 
mitting the  free  admission  of  wire  screens,  crude  petroleum,  mosquito  nets, 
quinine  salts,  for  the  purpose  of  promoting  the  fight  against  malaria  and  yel- 
low fever. 

Although  at  present  my  Government  is  devoting  its  best  attention  to  the  im- 
provement of  the  statistical  service,  this  important  branch  is  still  deficient.  Our 
figures  show  that  there  is  a  marked  difference  between  the  demographic  sta- 


108  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

tistics  of  the  cities  situated  on  the  inter-Andean  plateau  and  that  of  the  coast 
cities,  the  difference  being  in  favor  of  the  former,  where,  on  account  of  the 
altitude  and  cold  climate,  there  is  no  stegomya,  and  the  anopheles  can  not 
breed.     The  same  may  be  said  with  regard  to  tuberculosis  in  those  cities. 

The  general  death  rate  in  the  population  of  Quito,  80,000,  is  2.37  per  cent, 
the  most  frequent  causes  being  bronchitis,  pneumonia,  and  dysentery. 

The  percentage  of  mortality  due  to  tuberculosis,  and  other  epidemic  dis- 
eases is  as  follows : 

Per  cent. 

Tuberculosis  0.40 

Typhoid  fever 0.03 

Malaria 0.01 

Small-pox 0.02 

In  Guayaquil,  the  demographic  statistics  for  1910  show  a  death  rate  of  41.08 
per  thousand  in  a  population  estimated  at  82,000.  The  principal  causes  of 
death  are  as  follows : 

Per  cent  of  general  mortality. 

Tuberculosis 13.79 

Malaria 9.78 

Yellow  fever 4.61 

Plague 8.58 

It  is  true  that  the  death  rate  in  Guayaquil  is  high,  but  it  should  be  taken 
into  consideration  that  this  is  due  to  the  fact  that  there  go  to  that  port  a  great 
number  of  patients  from  other  points  of  the  Republic  seeking  cure  in  the  hos- 
pitals of  that  city  and  that  a  large  number  of  dead  from  neighboring  places 
are  buried  in  Guayaquil  and  recorded  as  taking  place  in  that  city.  We  hope, 
however,  to  materially  decrease  that  death  rate  with  the  improvement  soon  to 
be  undertaken. 

The  campaign  against  yellow  fever,  which  is  carried  on  most  actively,  is 
absolutely  along  the  lines  of  the  most  modern  theories  and  methods.  It  is 
carried  on  not  only  in  Guayaquil  but  also  in  the  surrounding  towns,  particu- 
larly in  the  railroad  zone  between  Duran  and  Bucay,  the  largest  focus  of  the 
disease,  which  the  greatest  number  of  patients  to  Guayaquil  lazaretto.  A  pro- 
visional lazaretto  will  soon  be  opened  in  Duran  for  the  isolation  of  the  cases 
from  that  zone.  On  the  other  hand,  the  public  is  being  educated  on  the  pre- 
vention of  the  disease,  by  means  of  publications,  posters,  etc. 

The  campaign  against  plague  is  also  carried  on  most  actively  in  Guayaquil, 
controlling  in  an  efficient  manner  every  new  outbreak.  The  complete  destruc- 
tion of  rats  is,  however,  difficult  on  account  of  the  nature  of  our  wooden 
buildings.  A  great  improvement  has  been  effected  in  Guayaquil,  in  the  matter 
of  building,  i.e.,  that  practically  all  the  old  wooden  gateways  have  been  re- 
placed for  others  of  stone  or  cement,  thus  rendering  them  rat  proof.  We 
will  gradually  do  the  same  thing  with  the  ground  floors  of  the  houses  so  that 
no  rats  can  live  under  them.  The  general  sanitary  condition  of  dwellings  has 
likewise  been  improved,  and  the  campaign  against  the  rodents  is  energetically 
enforced. 

The  lazarettos  are  under  the  control  of  a  medical  director  and  a  staff  of 
interns,  composed  of  senior  medical  students.  Besides  the  lazarettos  for  yel- 
low fever,  plague,  and  small-pox,  which  are  managed  by  the  Health  Service, 
this  bureau  has  established  and  maintains  an  observation  Hall  in  the  General 
Hospital,  where  all  patients  admitted  to  that  institution  are  carefully  examined 
before  being  assigned  to  the  respective  wards.  All  the  lazarettos  have  been 
built  along  the  most  modern  lines.  In  the  plague  lazaretto  there  has  been 
established  a  bacteriological  laboratory  for  the  verification  of  all  cases  and  the 
systematic  examination  of  rats. 

The  small-pox  lazaretto  has  been  closed  for  the  last  two  years,  there  having 
been  no  new  cases  during  that  period.  We  may,  therefore,  consider  this  dis- 
ease as  having  been  definitely  stamped  out  from  Guayaquil. 

The  maritime  health  section  is  under  the  Port's  Physician. 

The  Board  of  Municipal  Charities  has  recently  opened  the  Institute  of  Ani- 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  109 

mal  Vaccine,  built  in  accordance  with  all  modern  requirements;  it  will  furnish 
the  whole  Republic  with  the  virus  as  soon  as  the  law  of  compulsory  vaccination 
shall  have  been  passed  by  Congress.  The  great  Municipal  Chemical  labora- 
tory has  also  been  recently  inaugurated,  and  is  in  charge  of  the  able  German 
physician,  Dr.  Robert  Levi. 

The  municipal  government  of  Guayaquil  established  several  years  ago  two 
crematories,  which  are  regularly  operated  for  the  destruction  of  garbage. 

There  are  in  Guayaquil  several  modern  hospitals,  splendidly  equipped.  The 
General  Hospital  is  provided  with  clinical,  chemical,  bacteriological,  electrical 
and  radiographic  laboratories. 

Through  public  charities  under  the  initiative  of  the  great  philanthropist  and 
distinguished  physician.  Dr.  Leon  Becerra,  there  is  maintained  at  Guayaquil 
the  Society  for  the  Protection  of  Children,  founded  several  years  ago,  with  a 
medical  dispensary  for  children,  where  assistance  and  medicine  are  furnished 
free  to  the  poor. 

For  the  public  school  there  is  a  Bureau  of  School  Hygiene,  which  is  charged 
with  the  inspection  of  the  health  condition  of  teachers  and  pupils,  and  issues 
hygienic  rules  and  advice  as  to  the  preservation  of  health. 

The  sanitation  of  other  cities  is  also  properly  looked  after  by  the  respective 
sub-bureaus  of  health.  In  Quito  specially,  the  sanitary  conditions  have  im- 
proved considerably. 

I  have  taken  the  city  of  Guayaquil  as  the  basis  of  my  report  in  order  to 
show  the  sanitary  and  hygienic  improvements  that  have  recently  been  effected 
in  Ecuador,  and  also  to  let  you  know  what  we  are  doing  to  accomplish  the 
complete  sanitation  of  our  principal  port,  which  will  soon  be  realized  in  view 
of  the  success  so  far  attained. 

Now  then,  gentlemen,  a  country  which  thus  strives  to  improve  the  hygienic 
conditions  of  its  ports,  enforcing  sanitary  measures  of  inestimable  value  and 
with  evident  success  in  order  to  save  its  own  nationals  and  in  order  not  to 
constitute  a  menace  to  the  health  of  others,  deserves  not  to  be  excluded  from 
the  benefits  of  the  laws,  wisely  issued  and  jointly  adopted  by  nearly  all  the 
American  nations. 

Today  Ecuador's  commerce  suffers  considerably  on  account  of  the  stringent 
restrictions  enforced  against  its  principal  port;  there  are  no  longer  to  be  seen 
the  numerous  ships  of  all  nationalities  that  formerly  promoted  our  national 
commerce.  The  few  vessels  that  are  compelled  to  touch  in  Guayaquil  moor  at 
a  place  separated  by  a  distance  of  2,000  meters  from  the  commercial  center, 
which  renders  loading  and  unloading  difficult,  and  hinders  the  passenge* 
traffic. 

On  the  other  hand,  the  steamers  plying  between  Panama  and  Valparaiso 
have  been  obliged  to  do  away  with  the  stop  at  Guayaquil  because  their  pas- 
sengers in  transit  would  be  considered  as  coming  from  an  infected  port  and 
placed  under  quarantine  for  the  mere  fact  that  the  steamer  touched  at  a  dis- 
tance of  over  2,000  meters  away  from  the  city  and  loaded  and  unloaded  under 
quarantine. 

This  procedure,  which  attacks  directly  our  national  interests  and  works  to 
the  positive  detriment  of  continental  commerce,  compels  Ecuador  to  request 
this  Conference,  through  its  Delegates,  that  the  severe  sanitary  restrictions 
imposed  against  the  port  of  Guayaquil  be  attenuated  and  made  to  conform  with 
the   reasonable  prescriptions   wisely  stipulated   in   the  Washington   Convention. 

As  to  the  important  subject  as  to  what  constitutes  immunity  from  yellow 
fever,  I  believe  that  if  a  person  has  lived  for  twelve  years  in  a  focus  of  the 
disease  without  contracting  it  he  may  be  considered  as  immune  therefrom. 

The  defense  against  venereal  diseases  is  a  subject  which  demands  the  best 
attention  of  all  Governments.  I  believe  that  the  regulation  of  prostitution  is 
the  most  effective  means  to  prevent  the  spread  of  such  diseases ;  and  at  the 
same  time  a  propaganda  should  be  carried  on  in  order  to  educate  the  public 
as  to  the  evils  therefrom  and  as  to  the  manner  of  prevention. 


REPORT  BY  DR.  JUAN  B.  MIRANDA,  DELEGATE  FROM 

EL  SALVADOR. 

Mr.  Presidente:  Messrs.  Delegates:  The  Republic  of  El  Salvador,  whose 
Government  has  conferred  upon  me  the  honor  of  representing  it  before  this 
Conference,  has,  in  so  far  as  possible,  complied  with  the  provisions  adopted  by 
the  previous  conferences. 

The  Salvadorean  Government's  constant  aim  has  been  and  is  to  enforce  in  a 
practical  way  all  health  laws  and  regulations  tending  to  the  sanitation  of  cities, 
ports  and  towns  and  to  safeguard  the  lives  of  their  inhabitants.  The  Chief 
Executive  fully  realizes  that,  by  giving  the  best  attention  to  all  public  sanitary 
measures,  he  not  only  benefits  the  material  interest  of  commerce,  but  also 
renders  a  deserved  tribute  to  the  Science  of  Life,  which  is  the  unanimous 
aspiration  of  humanity. 

It  is  a  well  known  fact  that  there  is  in  force  in  El  Salvador  since  1900  a 
Sanitary  Code  which  contains  all  sanitary  regulations  and  provides  for  all 
measures  that  should  be  taken  in  case  of  an  epidemic,  whether  imported  or 
originated  in  the  country.  It  contains  also  hygienic  regulations  for  railroads, 
Hotels,  barber  shops,  church,  and  other  public  places ;  and  for  the  sale  of 
liquors,  beverages  and   foodstuffs. 

Vaccination  is  compulsory,  and  medical  inspection  of  schools  and  other  edu- 
cational establishments  is  periodically  carried  on. 

Yellow  fever,  which  was  formerly  rather  frequent,  has  practically  disap- 
peared. 

Malaria,  which  until  recently  used  to  cause  numerous  victims,  has  decreased 
considerably;  this  endemic  disease  prevails  only  in  the  coast.  The  Govern- 
ment enforces  all  measures  recommended  by  science  in  order  to  fight  the  dis- 
ease. 

In  order  to  fight  tuberculosis,  which  is  responsible  for  high  death  rate,  there 
have  been  organized  associations,  which  are  efficiently  supported  by  the  Gov- 
ernment. 

For  the  purpose  of  educating  the  people  in  matters  of  hygiene,  popular 
pamphlets  are  published  and  freely  distributed,  showing  the  methods  of  pre- 
venting and  curing  tuberculosis  and  other  infectious  diseases.  Large  posters 
are  also  fixed  in  conspicuous  places   for  the  same  purpose. 

The  water  supply  of  cities  is  also  the  subject  of  the  Government's  particu- 
lar attention. 

There  is  a  Board  of  Health  vested  with  ample  authority  to  look  after  the 
public  hygiene  of  the  Nation. 


< 


do 

do 

do 

do 

do 

do 

do 

do 

do 

on 

REPORT  OF  THE  GUATEMALAN  DELEGATION,  COM- 
POSED OF  DR.  SALVADOR  ORTEGA  AND  JULIO 
BIANCHI. 

Messrs.  Delegates :  In  pursuance  of  the  provisional  program  for  this  Con- 
ference, we  have  the  honor  to  submit  the  following  report : 

I. 

Most  of  the  sanitary  provisions  and  regulations  mentioned  in  the  following 
were    enacted    in    1908,    but    did   not   become    effective    until   the    beginning    of 
1909.     This  is  the  list : 
Regulations  governing  bakeries. 

barber  shops, 
butcheries, 
street  cleaning, 
bathing  establishments, 
compulsory    report    of    infectious    diseases,   and    special 
prophylactic    measures    for   the   prevention   of    small-pox,    scarlet    fever,    diph- 
theria, typhus,  etc. 

Bilharziosis  is  unknown  in  Guatemala. 

Leprosy  is  comparatively  rare,  from  twelve  to  fifteen  lepers  being  treated 
annually  at  La  Piedad  Asylum ;  specially  maintained  for  lepers. 

One  confirmed  case  of  rabies  was  observed  last  year  in  the  capital.  The 
regulation  ordering  the  capture  of  all  stray  dogs  and  compelling  owners  to 
keep  their  dogs  muzzled  has  had  a  successful  result. 

Exanthematic  typhus  worked  havoc  during  some  time,  principally  in  the 
army.  Thanks  to  the  disinfection  of  all  equipments  and  harnesses  it  has  now 
almost  totally  disappeared. 

Anchylostomiasis  prevails  in  the  following  places :  Chocola,  Chitalon, 
Trapiche  Grande,  Ixtapaca.  Various  pamphlets  prepared  by  the  Faculty  of 
Medicine  on  the  manner  of  contracting  and  preventing  the  disease  have  been 
widely  distributed  among  the  farmers  in  those  places.  This  disease,  however, 
has  never  appeared  in  considerable  proportions. 

II. 

To  improve  the  sanitation  of  ports  Health  Physicians  have  been  appointed 
in  the  principal  ones  (San  Jose,  Puerto  Barrios,  Livingston,  and  Champerico), 
whose  principal  function  is  to  prevent  the  importation  of  such  diseases  as 
cholera,  yellow  fever,  and  plague.  For  the  same  purpose,  Puerto  Barrios  will 
soon  be  provided  with  Panama  iron  tanks,  which  are  mosquito  proof,  and  the 
city  is  to  be  supplied  with  water  from  the  Escondido  River. 

Through  lack  of  bacteriological  experts,  there  have  not  yet  been  established 
any  laboratories  in  the  ports. 

The  crusade  against  mosquitoes  is  carried  on  most  vigorously.  By  means  of 
pamphlets  and  posters,  the  public  is  being  educated  with  regard  to  the  trans- 
mission and  prevention  of  malaria  and  yellow  fever.  The  customs  duties  on 
quinine  salts,    formaline,   mosquito  nets,  and  wire  gauze  have  been  abolished. 

In  all  public  schools  the  pupils  are  taught  how  to  guard  against  yellow 
fever,  malaria,  and  tuberculosis.  Popular  lectures  with  lantern  slides  are  held 
for  the  same  purposes. 

In  all  the  ports  of  the  Republic  special  care  is  taken  to  prevent  the  em- 
barkation of  persons  suffering  from  infectious  diseases.  In  Puerto  Barrios, 
our  principal  port,  nobody  is  permitted  to  embark  unless  he  produces  a  cer- 
tificate to  the  effect  that  he  is  vaccinated  and  in  good  health. 

Although  plague  and  cholera  do  not  exist  in  the  Republic,  publications  have 
been  distributed  showing  the  manner  of  preventing  those  dread  diseases. 


114  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

In  order  to  be  prepared  for  an  invasion  of  yellow  fever  or  plague,  several 
Clayton  apparatus  have  been  imported  for  the  destruction  of  mosquitoes  and 
rodents. 

In  order  to  comply  with  the  recommendation  regarding  experts  on  para- 
sitology and  pathological  anatomy,  the  Government  has  sent  several  physicians 
to  Europe  who  are  now  studying  those  subjects  and  bacteriology,  with  a  view 
to  establishing  in  the  country  a  Pasteur  institute. 

The  Government  has  adopted  the  models  for  sanitary  documents  recom- 
mended by  the  Conference  of  San  Jose  de  Costa  Rica. 

III. 

The  movement  of  the  population  in  the  capital  and  its  suburbs  during  the 
last  two  years  was  as  follows:  1909— births,  3,178;  deaths,  3,667;  1910 — 
births,  4,754;  deaths,  4,188. 

The  principal  causes  of  death  were  as  follows,  with  numbers  of  death : 

1909.  1910. 

Intestinal    worms    315  228 

Pneumonia 302 

Tuberculosis 325  230 

Small-pox   216 

Pulmonar    catarrh    178  149 

Dysentery 84 

Whooping    cough    10 

Typhoid    fever     17 

The  movement  of  the  population  in  the  whole  territory  of  the  Republic  was 
as  follows:  i909— births,  69,943;  deaths,  52,160.  1910— births,  74,498;  deaths, 
35,077.  Thus,  the  increase  of  population  in  1909  was  17,783,  and  in  1910, 
39,421. 

IV. 

June  8,  1906,  may  be  considered  as  the  starting  point  of  the  work  to  improve 
the  sanitary  conditions  of  Guatemala,  as  on  that  date  the  Supreme  Board  of 
Health  was  created.  This  body  is  governed  by  the  Organic  Code  of  Public 
Health,  which  contains  also  all  the  provisions  of  the  Washington  Convention 
of  1905.  Besides  the  Supreme  Board,  there  are  the  Departmental  and  local 
boards. 

To  prevent  the  propagation  of  infectious  diseases,  we  have  a  lazaretto  and 
a  public  disinfection  station. 

In  the  lazaretto,  which  is  located  in  the  suburbs  of  the  capital,  are  confined 
all  cases  of  infectious  diseases.  This  establishment  renders  important  serv- 
ices, as,  for  instance,  in  the  small-pox  epidemic  of  1908-9  there  were  treated 
1,380  cases,  of  which  31  per  cent  died. 

In  order  to  guard  the  nation  against  the  invasion  and  propagation  of  this 
dread  scourge,  which  in  the  epidemics  of  1883-84  and  1890-91  caused  over 
80,000  victims,  the  present  administration  ordered  recently  the  establishment  of 
an  Institute  of  A'.iimal  Vaccine,  thanks  to  which  the  epidemic  of  1908  did  not 
assume  alarming  proportions.  Since  its  creation  and  up  to  June  30,  1911,  the 
Institute  has  manufactured  1,314,689  doses  of  virus.  During  the  year  1909, 
there  were  made  1,783,365  vaccinations.  When  the  Institute  of  Vaccine  was 
opened  there  had  been  already  imported  from  abroad  large  quantities  of  virus. 
This  accounts  for  the  fact  that  during  1909  alone  there  was  more  vaccination 
than  the  number  of  doses  manufactured  in  the  country. 

The  epidemic  that  appeared  recently  in  several  departments  of  the  Republic 
was  fought  by  24  commissions  of  physicians  and  students,  who  were  provided 
with  everything  necessary  for  the  organization  of  lazarettos  and  for  proper 
treatment  of  patients. 

Among  the  inhabitants  of  the  Republic  we  sincerely  believe  that  there  are 
very  few  who  have  not  been  vaccinated,  not  only  because  vaccination  is  com- 
pulsory, but  also  because  the  authorities  and  physicians  have  always  cooperated 
in  order  to  carry  out  this  most  important  measure. 


FIFTH   INTERNATIONAL  SANITARY   CONFERENCE.  115 

There  is  a  well  organized  street  cleaning  department  in  the  capital,  which 
is  also  charged  with  the  removal  of  refuse  and  garbage  from  houses.  All 
the  refuse  thus  gathered,  as  also  all  dead  animals,  are  incinerated  in  the 
Municipal  Crematory,  inaugrated  in  1908  with  machinery  from  New  York. 
It  has  a  capacity  for  15  tons  of  garbage  per  day. 

One  of  the  most  important  improvements  in  the  capital  has  been  the 
repaying  of  the  streets.  The  old  sewer  system  is  gradually  being  replaced 
with  a  new  one.  The  city  is  provided  with  an  abundant  and  excellent  water 
supply,  which  will  soon  be  further  increased. 

In  other  cities  of  the  Republic  sanitary  improvements  are  being  carried 
with  great   activity. 

V. 

The  old  regulations  on  prostitution  being  deficient,  new  ones  have  been 
drafted  which  fully  meet  all  the  requirements  of  modern  hygiene.  We  can  not 
report  upon  them  because  the  Government  Attorney  has  them  still  under  con- 
sideration. 


REPORT  OF  THE  DELEGATE  FROM  MEXICO,  DR.  JESuS 

MONJARAS. 

1.  Laws  of  sanitary  police  and  health  measures  adopted  since  the  Fourth 
Conference. 

After  the  Fourth  Conference,  held  in  San  Jose  de  Costa  Rica,  the  President 
of  the  Republic,  by  authority  of  Congress,  issued  the  following  legal  pro- 
visions : 

(1)  Declaring  as  infected  certain  ports  which  had  been  invaded  by  cholera. 

(2)  Providing  that  only  Tampico,  Veracruz  and  Progreso  should  be  opened 
to  vessels  coming  from  said  infected  ports,  and  that  on  othei  ports  on  the 
Gulf  of  Mexico  should  be  closed  to  arrivals  therefrom. 

(3)  Providing  that  Coatzacoalcos  shall  be  opened  only  for  the  purpose 
of  unloading  vessels. 

To  enforce  the  above  provisions,  the  Supreme  Board  of  Health  issued  per- 
tinent regulations. 

(4)  Decree  reorganizing  the  Mexican  Red  Cross.  This  institution  has  been 
entrusted  also  with  the  assistance  in  cases  of  public  calamities. 

2d. — Compliance  with  the  Resolutions  Adopted  by  the  First,  Second  and 
Third  Sanitary  Conferences. 

In  the  reports  submitted  by  the  Mexican  Delegations,  to  those  Conferences 
an  account  is  given  as  to  the  manner  in  which  the  resolutions  of  each  previous 
conference  had  been  complied  with.  So  that  in  the  present  report  I  shall 
confine  myself  to  the  resolutions  of  the  Fourth  Sanitary  Conference  of  San 
Jose  de  Costa  Rica. 

With  reference  to  the  first  of  these  latter  resolutions,  I  have  to  state  that  the 
measures  of  isolation  and  disinfection  prescribed  in  the  Sanitary  Code  and 
its  regulations,  are  applied  to  all  cases  of  infectious  diseases.  With  regard  to 
rabies,  I  will  say  that  there  are  in  Mexico  several  anti-rabic  institutes,  similar 
to  the  Pasteur  Institute  of  Paris,  where  all  anti-rabic  infections  are  duly 
and  carefully  applied.  The  success  of  these  treatments  has  been  so  complete 
that  not  one  single  infection  of  the  thousands  of  cases  that  have  been  thus 
so  far  treated,  has  failed,  and  our  statistics  do  not  show  one  single  case 
where  an  individual  treated  has  shown  the  symptoms  of  the  disease.  All  cases 
of  rabies  occurring  in  animals  are  duly  verified  by  all  known  methods,  and 
whenever  possible  by  the  Negree  process.  On  the  other  hand  the  sanitary 
authorities  capture  all  dogs  in  the  streets ;  dogs  owned  by  residents  are  re- 
quired to  be  muzzled  and  tied. 

Concerning  exanthematic  typhus,  there  are  now  being  carried  on  in  Mexico 
scientific  investigations  in  order  to  discover  the  patogenic  agent,  the  manner 
of  transmission  of  the  disease,  and  its  serotherapy.  To  this  end  the  govern- 
ment offers  a  prize  of  $50,000  for  works  leading  to  positive  practical  results. 
This  competition  is  open  to  physicians  and  scientists  all  over  the  world.  At 
the  same  time  the  Supreme  Board  of  Health  enforces  energetic  measures  to 
prevent  the  spread  of  this  dread  disease. 

Speaking  of  the  II  resolution,  Mexico  has  improved  or  is  improving  the 
sanitary  conditions  of  its  first  and  second  class  ports,  and  of  those  which,  by 
virtue  of  the  Washington  Convention  are  the  only  ones  where  may  be  admitted 
arrivals  from  localities  infected  from  cholera,  plague  or  yellow  fever.  Sani- 
tary inspectors  have  been  trained  and  laboratories  established  for  the  assist- 
ance of  passengers  suffering  or  suspected  of  any  of  said  diseases,  including 
such  persons  as  may  be  bacillus  carriers.  Said  ports  are  also  equipped  with 
modern  sanitary  stations  and  lazarettos.  There  are  in  the  capital  of  the 
Republic  fully  equipped  bacteriological  laboratories,  a  pathological  laboratory 
and  a  parasitological  laboratory. 

With  regard  to  par.  (b)  of  resolution  II,  I  must  say  that  in  Mexico  in 
order  to  construct  a  building  it  is  necessary  to  obtain  previously  a  permit 
from  the  Supreme  Board  of  Health,  which  sees  to  it  that  the  plans  conform 
with    all    sanitary   requirements. 


118  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

With  reference  to  paragraph  (c)  of  the  same  resolution,  it  is  strictly  com- 
plied with  in  Mexico,  and  persons  violating  its  provisions  are  liable  to  pun- 
ishment as  provided  for  in  the  Sanitary  Code  of  the  Republic. 

The  first  of  these  answers  covers  what  relates  to  paragraph    (d). 

Referring  to  paragraph  (e),  I  will  say  that  the  campaign  against  yellow 
fever  and  malaria  actively  carried  on  in  Mexico  throughout  the  year,  along 
the  lines  set  forth  in  the  report  of  the  Mexican  Delegation  to  the  Third 
Conference.     (See  pages  207  to  211  of  the  Transactions  thereof.) 

As  to  resolution  III,  I  will  state  that  its  provisions  are  strictly  complied 
with;  as  also  those  contained  in  paragraphs  (b),  (c)  and  (d)  of  said  reso- 
lutions, which  are  included  in  the  prescriptions  of  the  Sanitary  Code  and  its 
regulations. 

The  requirements  of  resolution  IV  are  strictly  enforced  in  Mexico  by  virtue 
of  the  Maritime  Health  Regulations.  Besides,  all  vessels  engaged  in  the 
transportation  of  immigrants  are  equipped  with  Clayton  or  Marot  disinfecting 
apparatus,  as  also  are  some  of  the  vessels  for  the  transportation  of  passen- 
gers. First  and  second  class  ports  are  likewise  provided  with  everything  that 
is  necessary  for  the  proper  disinfection  of  ships. 

With  regard  to  resolution  5,  the  Sanitary  Code  and  the  Maritime  Health 
Regulations  contain  provisions,  which  are  strictly  enforced,  as  to  the  require- 
ments that  should  be  observed  before  allowing  passengers  to  board  the  vessel. 

Concerning  resolution  VII,  I  will  say  that  the  sanitary  authorities  of  Mexico, 
in  order  to  declare  a  person  immune  from  yellow  fever,  require  that  such 
person  shall  have  suffered  an  attack  of  the  disease.  In  this  connection  there 
are  being  carried  on  experiments  to  ascertain  the  true  condition  of  immunity 
and   prevention. 

Reporting  upon  resolution  VIII,  I  state  that  the  Supreme  Council  of  Health 
has  distributed  thousands  of  pamphlets,  and  has  held  illustrated  conferences 
to  educate  the  public  in  regard  to  the  diseases   referred  to  in  the  resolution. 

As  to  resolution  IX,  the  Supreme  Board  of  Health  has  now  under  con- 
sideration, and  will  submit  to  Congress,  a  bill  amending  the  Sanitary  Code 
and  its  regulations,  among  which  amendments  are  included  the  recommenda- 
tions of  this  resolution. 

Resolutions  XI  and  XII  have  been  covered  in  the  answer  to  resolution  II. 

(5)  Sanitation  of  cities  and  especially  of  ports. 

This  subject  has  been  covered  in  the  report  of  the  Mexican  Delegation, 
which  appears  in  pages  218  and  219  of  the  Transactions  of  the  Third  Sani- 
tary  Conference. 

(6)  Prophylactic  measures   against  plague   and  yellow   fever. 

Mexico  has  continued  to  enforce  the  same  prophylactic  measures  of  which 
report  has  been  made  to  previous  Conferences. 

(7)  What  constitutes  immunity  from  yellow  fever? 

This  question  has  been  answered  in  the  paragraph  relating  to  resolution 
VIII. 

(8)  National  and  international  prophylaxis  of  tuberculosis,  venereal  dis- 
eases, malaria,  trachoma,  leprosy  and  escleroma. 

This  subject  is  covered  in  the  answer  to  resolution  I. 

(9)  Monthly  and  annual  statistics  of  morbility  and  mortality  in  the  principal 
ports  and  cities. 

Mexico  uses  since  1892  the  nomenclature  of  Bertillon  (now  internationally 
adopted).  With  regard  to  the  monthly  and  annual  statistics  of  the  morbility 
and  mortality  of  the  principal  ports  and  cities,  they  are  kept  regularly. 

(10)  Sanitary  inspection  of  international,  maritime  and  domestic  traffic  with 
regard  to  cases  of  transmissible  diseases. 

For  the  sanitary  inspection  of  transmissible  diseases,  Mexico  enforces  fully 
the  provisions  of  the  Sanitary  Convention  of  Washington,  as  contained  in  the 
Sanitary  Code  and  its  regulations. 

(11)  Sanitary  immigration  laws. 

To  answer  this  subject,  I  refer  to  the  report  of  the  Mexican  Delegation  to 
the  Fourth  Sanitary  Conference. 

(12)  Data  on  the  adoption  of  the  maritime  sanitary  documents  approved 
by  the  Fourth  Conference. 

This  subject  is  covered  by  the  answer  to  resolution  XIV. 


REPORT  PRESENTED  BY  THE  DELEGATE  FROM  PARA- 
GUAY, DR.  ROGELIO  URIZAR. 

Gentlemen :  The  Republic  of  Paraguay,  although  heretofore  absent  from 
these  International  Sanitary  Conferences,  has  established  its  internal  and 
external  defense  in  accordance  with  modern  methods.  Its  external  defense, 
that  is  to  say,  its  international  sanitary  police,  is  regulated  under  the  agree- 
ments signed,  first  at  Montevideo,  and  later  at  Rio  Janeiro  in  1904,  with  the 
Argentine  Republic,  Brazil,  and  Uruguay.  Said  agreements  are  copied  from 
the  conclusions  reached  at  the  Paris  Conference  of  1903. 

The  interior  defense  of  Paraguay  may  be  said  to  be  in  process  of  develop- 
ment. The  republic  being  an  unusually  healthy  country,  the  legislature  has 
found  it  unnecessary  to  give  much  attention  to  health  matters,  except  when  once 
in  a  while  some  diseases  appeared  which  required  the  enforcement  of  sanitary 
measures. 

Formerly,  there  was  in  the  capital  a  Board  of  Medicine  which  was  later 
reorganized  as  a  Board  of  Health,  with  more  specialized  duties.  This  Board 
was  composed  of  a  president,  a  secretary  and  several  members,  two  of  which 
were  pharmacists.  All  were  appointed  by  the  Executive.  The  resolutions 
passed  by  the  board  were,  therefore,  belated  and  inefficient. 

Consequently,  by  a  law  of  Congress  the  board  was  in  1900  reorganized  into 
a  Department  of  Hygiene,  something  like  a  sub-Ministry  of  Public  Health. 
The  Director  of  the  Department  of  Hygiene  is  to-day  the  highest  sanitary 
authority  in  the  country,  and  is  under  the  immediate  control  of  the  Minister 
of  the  Interior.  If  the  Constitution  of  the  Republic  did  not,  as  it  does,  fix  the 
number  of  cabinet  officers,  health  affairs  would  by  this  time  be  under  a  new 
executive  department. 

The  powers  and  duties  of  the  Director  of  the  Department  of  Hygiene  are 
very  ample,  because  he  not  only  enforces  the  health  laws,  but  also  interprets 
them  and  recommends  the  adoption  of  such  new  measures  as  he  deems 
necessary. 

Under  the  Department  of  Hygiene  are:  (1)  The  National  Institute  of 
Bacteriology,  in  charge  of  the  preparation  of  serums  and  vaccines  and  of  the 
diagnosis  of  infectious  diseases  in  the  whole  territory  of  the  Republic,  whether 
endemic  or  epidemic,  and  whether  human  or  animal.  As  a  division  of  the 
Institute  there  is  a  National  Vaccine  Conservatory  which  has  produced  enough 
virus  to  vaccinate  almost  all  the  inhabitants  of  the  country,  including  several 
hundreds  of  Indians  in  the  Chaco  region.  For  the  diagnosis  in  infectious  dis- 
eases, the  Institute  is  provided  with  a  complete  laboratory,  where  there  are 
made  cultures,  inoculations,  reactions,  etc.  Thus,  Paraguay  is  fully  equipped 
to  comply  with  the  clause  of  the  sanitary  agreement  requiring  the  immediate 
notification   and   localization   of   foccu   of   infection. 

(2)  A  section  of  the  Department  of  Hygiene  is  also  the  division  of  disin- 
fections and  sterilizations,  composed  of  a  chief,  six  inspectors  and  several 
companies  of  guards,  whose  number  may  be  increased  whenever  necessary. 
It  is  die  duty  of  this  division  to:  disinfect  vessels;  inspect  and  supervise 
the  cleaning  thereof;  destroy  rats  aboard  and  fumigate  the  said  vessels, 
and  sterilize  clothing,  for  all  of  which  it  is  provided  with  the  necessary  appa- 
ratus and  instruments.  It  is  also  charged  with  the  disinfection  of  dwellings, 
utensils,  churches,  barracks,   schools,  theaters  and  other  public  buildings. 

(3)  The  Division  of  Sanitary  Inspection,  under  a  physician  of  the  Depart- 
ment, with  a  personnel  composed  of  the  hygiene  inspectors  of  the  Municipality 
of  Asuncion.     This  division  is  charged  with  the  supervision  of  drug  stores. 

(4)  The  Isolation  Division,  which  has  in  the  suburbs  of  the  capital  several 
"houses  of  isolation,"  thus  called  to  do  away  with  the  name  "lazaretto," 
which  is  feared  by  the  people.  This  division  is  also  provided  with  an  ambu- 
lance service  for  the  transportation  of  patients.  The  use  of  these  houses  is  al- 
most exclusively  devoted  to  the  prophylaxis  of  plague. 


120  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

With  the  above  described  organization,  the  sanitary  defense  of  the  country 
is  effected  under  the  following  legislation : 

(1)  Law  of  compulsory  vaccination,  which  has  been  in  force  for  over  2 
years. 

(2)  Law  compelling  physicians  to  report  all  cases  of  infectious  diseases 
coming  under  their  notice. 

(3)  Law  creating  a  permanent  annual  appropriation  for  the  expenses  of  the 
health    service. 

(4)  Law   creating  the   Department  of  Hygiene,   and  its   regulations. 

(5)  Municipal  ordinances  in  public  buildings,  vehicles,  foodstuffs  and 
beverages. 

Under  these  laws  the  Department  is  authorized  to  issue  such  regulations  as 
it  may  deem  wise  for  the  proper  enforcement. 

The  prophylaxis  of  leprosy  is  a  question  that  engages  the  best  attention  of 
the  Paraguayan  Government,  because  where  ten  years  ago  there  were  only  a 
few  cases  imported  from  abroad,  there  are  now  entire  families  which  are 
veritable  leper  colonies.  I  believe  that  it  is  high  time  for  the  American  Gov- 
ernment to  reach  an  agreement  on  the  prophylactic  measures  against  this, 
dread  disease  so  widely  scattered  the  world  over.  And  I  take  advantage  of 
this  opportunity  to  move  that  the  Fifth  International  Sanitary  Conference 
pass  a  resolution  recommending  the  countries  where  the  disease  prevails  to 
collect  minute  and  detailed  statistics  of  the  number  of  lepers  in  each  country, 
and  to  establish  leper  colonies,  like  those  maintained  by  the  United  States 
Government. 

Like  leprosy,  tuberculosis  was  a  disease  almost  unknown  in  Paraguay.  But 
the  beneficial  climate  of  my  country  attracts  thereto  every  year  a  large  num- 
ber of  consumptives,  who  have  generously  spread  the  germs  of  so  terrible 
a  scourge.  The  Department  of  Hygiene  is  now  exerting  all  possible  efforts 
in  order  to  fight  the  disease. 

The  prophylaxis  of  venereal  diseases  is  carried  on  under  municipal  regula- 
tions, which  tolerate  prostitution.  In  the  schools  children  are  taught  how  to 
abhor   certain   diseases   and   the  manner   of  preventing   them. 

Malaria,  which  is  frequent  in  damp  places,  is  so  mild  in  Paraguay  that  it 
is  usually  cured  by  the  single  administration  of  a  purgative.  The  chronic  form 
is  not,  however,  unusual,  but  it  is  as  a  rule  curable.  Death  on  account  of 
malaria  occurs  only  in  the  yerba  mate  plantations  of  the  north  and  east, 
where  the  disease  is  endemic. 

Ankilistuniaris  is  one  of  the  principal  causes  of  the  weakening  of  the  race, 
because  as  a  rule  it  attacks  the  peasants  living  in  places  remote  from  towns 
and  who  do  not  know  how  to  cure  or  defend  themselves.  For  the  purpose  of 
educating  the  people  with  regard  to  the  manner  of  infection  and  prevention 
the  Department  distributes  pamphlets  on  the  disease. 

Gastro-enteritis  and  tetanus  neo-natorum  were  until  recently  two  of  the 
greatest  causes  of  death.  In  order  to  check  the  ravages  of  the  former,  the 
Department  of  Hygiene  maintains  special  dispensaries  where  mothers  are 
taught  how  to  feed  their  babies,  and  while  nursing  they  are  kept  under  ob- 
servation, and  the  children  weighed  and  examined  regularly.  Tetanus  neo- 
natorum has  almost  disappeared  since  the  municipalities  provided  for  a  suf- 
ficient number  of  municipal  midwives  who  are  charged  with  the  duty  of 
attending  poor  women. 

Of  the  three  worst  scourges  of  humanity,  cholera,  yellow  fever  and  plague, 
only  the  latter  has  gotten  a  foothold  in  Paraguay,  but  only  in  a  form  so  mild 
that  its  death  rate  is  very  low.  Only  in  two  places  of  the  Republic  cases  of 
plague  occur  once  in  a  while ;  Asuncion  and  Conception.  In  this  connection 
and  before  closing,  I  must  mention  the  good  results  obtained  in  Paraguay 
with  the  anti-plague  sero-vaccination,  the  use  of  which  should  be  recommended 
in   epidemics. 


The    Late    Dr.    Walter    Wyman,    Surgeon    General,    United    States    Public 
Health    and    Marine    Hospital    Service. 

President  of  the  First  and  Second  International  Sanitary  Conferences  of 
American  Republics,  and  Chairman  of  the  International  Sanitary  Bureau 
of  Washington. 

He    died   suddenly   on   November    21,    1911. 

We  fulfill  a  painful  duty  upon  paying  from  these  pages  a  homage  of  respect 
to  the  memory  of  Dr.  Wyman,  apostle  of  public  hygiene  in  the  Western 
Hemisphere.  His  attractive  personality,  his  incessant  activities  in  behalf 
of  public  health,  and,  above  all,  the  sincere  admiration  and  sympathy 
which  he  always  showed  for  the  countries  of  Latin  America,  with  whose 
hygienists  he  co-operated  efficiently,  won  for  him  the  respect  and  affection 
of  the  officials  and  other  distinguished  men  of  those  nations,  as  well  as  of 
all   those  who  had  the   privilege   of  coming  in  contact  with   him. 

Dr.  Wyman  was  born  in  St.  Louis,  Mo.,  in  1848.  After  graduating  from  the 
School  of  Medicine  of  that  city,  he  joined  the  Public  Health  and  Marine 
Hospital  Service  in  1876.  Since  then,  devoted  to  the  solution  of  hygiene 
problems,  he  soon  attained  a  prominent  position  in  the  medical  world. 
Once  at  the  head  of  the  Service  he  reorganized  it  and  broadened  the 
scope  of  its  activities,  to  such  an  extent  that  it  has  now  achieved  a  high 
degree   of   efficiency  and   usefulness. 

United  States  has  lost  one  of  its  most  valuable  men;  Latin  America  a  sincere 
friend,  and  his  colleagues  of  the  Sanitary  Conference,  the  beloved  brother, 
the  respected  teacher.  But  in  our  hearts  his  memory  shall  forever  live, 
his  remembrance  shall  guide  the  deliberations  of  our  future  conferences, 
and  his  spirit,  fervently  invoked,  shall  preside  over  all  sessions  of  these 
gatherings    initiated    by   his    far-seeing   mind. 

May  he  rest  in  peace! 


REPORT  OF  DRS.  GREGORIO  M.  GUITERAS  AND  J.  C. 
PERRY,  DELEGATES  FROM  THE  UNITED  STATES  OF 
AMERICA. 

The  Delegation  from  the  United  States  of  America  to  the  Fifth  International 
Sanitary  Conference  submitted  the  following  reports  in  accordance  with  the 
provisions   of   the   Program   of   the   Conference:   * 

SANITARY    LEGISLATION    IN    THE    UNITED     STATES. 

National. 

Practically  no  new  sanitary  legislation  has  been  enacted  by  the  National 
Congress  since  the  Conference  held  in  San  Jose,  C.  R.  One  exception  is  the 
provision  made  by  the  61st  Congress,  2d  Session,  whereby  there  may  be 
admitted  to  marine  hospitals  for  purposes  of  scientific  study,  cases  of  con- 
tagious and  infectious  diseases  not  to  exceed  ten  in  any  one  hospital  at  any 
one  time.  This  measure  is  an  important  aid  in  the  conduct  of  investigations 
already  begun,  and  offers  increased  facilities  for  future  investigations.  Another 
exception  is  the  provision  in  the  laws  of  1910  appropriating  $40,000  to  enable 
the  President  to  check  the  prevalence  of  contagious  and  infectious  diseases 
among  the  Indians,  five  tuberculosis  sanatoria  exclusively  for  persons  of  the 
Indian  race  having  been  erected  in  different  parts  of  the  country  under  this 
provision. 

Different  attempts  have  been  made  to  secure  the  enactment  of  laws  con- 
ferring further  powers  on  the  federal  health  organization,  but  none  of  these 
attempts   have  so   far   been   successful. 

State  Legislation. 

Quite  a  mass  of  far-reaching  health  legislation  has  been  enacted  in  the 
last  two  years  in  the  different  States  of  the  Union,  the  most  important  of 
which   is   briefly  abstracted   here. 

Health  Organisation. — Considerable  changes  were  made  in  the  laws  govern- 
ing the  sanitary  organization  of  various  States.  Nevada,  North  Carolina  and 
Porto  Rico  revised  their  former  laws  with  a  view  to  strengthening  the  State 
Board  of  Health,  and  increasing  the  efficiency  of  local  health  authorities. 
In  Virginia  the  powers  of  the  State  Board  of  Health  were  greatly  augmented, 
it  being  given  authority  fo  appoint  local  boards  of  health;  in  Vermont  the 
sphere  of  action  of  local  health  officers  was  given  more  amplitude  and  that 
of  local  boards  of  health  diminished  proportionally;  in  Wisconsin,  further 
duties  were  imposed  on  local  health  officers ;  the  State  Board  of  Health  of 
Maryland  was  reorganized  into  a  number  of  bureaus,  a  measure  which  is 
intended  to  facilitate  the  .discharge  of  its  duties;  a  number  of  specific  powers 
in  regard  to  sanitation  were  vested  in  the  State  Board  of  Health  of  Kentucky; 
in  California  the  control  of  the  State  laboratory  was  definitely  given  to  the 
State  Board  of  Health,  power  given  to  establish  branch  laboratories  in  different 
parts  of  the  State,  and  minor  changes  being  made  in  the  office  force  of 
the   Board. 

Communicable  Diseases. — The  tendency  in  the  last  two  years  has  been  gener- 
ally towards  increasing  the  number  of  reportable  diseases  and  facilitating  their 
control  by  the  State  health  authorities.  In  New  York  a  State  laboratory  was 
created  for  the  study  of  cancer.  The  State  Board  of  Health  of  Iowa  was 
given  far  more  latitude  in  the  preparation  of  regulations  governing  quarantine 
and  disinfection.  The  State  Board  of  Health  of  Virginia  was  empowered 
to  designate  what  diseases  are  to  be  reported  in  that  State.  A  list  of  11 
diseases  was  immediately  prepared  by  that  board,  and  adequate  instructions 
was  issued   for  *their  control.     The  Sanitary  Code  of   Texas  was  given    force 


122  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

of  law  by  the  legislature,  thus  compelling  compliance  with  its  numerous  provi- 
sions relative  to  reporting,  disinfection  and  quarantine  of  cases  of  the  25 
diseases  mentioned  therein.  Recent  laws  have  added  10  diseases  to  those 
already  reportable  in  Utah,  7  in  the  case  of  California,  3  each  in  the  case  of 
North  Carolina  and  Rhode  Island,  2  in  the  case  of  New  Hampshire,  and  1 
each  in  the  case  of  Iowa  and  Indiana,  while  in  the  exercise  of  their  powers 
the  State  health  authorities  have  added  13  diseases  to  their  previous  lists  in 
Washington,  7  in  Florida,  4  in  Porto  Rico,  3  in  Pennsylvania,  2  in  Idaho,  and 
1  each  in  Maine,  New  Jersey,  South  Carolina,  Tennessee,  and  Wisconsin.  In 
addition,  revised  lists  of  reportable  diseases  were  issued  by  the  State  Boards 
of  Health  of  Oklahoma  (16  diseases),  and  New  York  (22  diseases),  thus 
making  at  present  eight  States  which  have  under  more  or  less  effective  control 
20  or  more  diseases;  namely,  California  (31),  Louisiana  (20),  Massachusetts 
(21),  New  York  (22),  Pennsylvania  (.33),  Texas  (25),  Vermont  (24),  and 
Washington    (22). 

The  unusual  prevalence  of  some  diseases  or  the  realization  by  the  public 
of  their  importance  forced  action  as   follows : 

Hookzvorm. — Made  reportable  in  Virginia,  Pennsylvania,  and  Washington. 

Poliomyelitis  (anterior)  was  made  reportable  in  Florida,  Iowa,  Idaho,  New 
Jersey,  New  York,  Massachusetts,  Pennsylvania,  Rhode  Island,  South  Caro- 
lina, Tennessee,  Utah,  California,  Washington,  Maine,  Wisconsin.  Investiga- 
tions of  the  disease  were  also  authorized  by  law  in  Rhode  Island. 

Pellagra. — Made  reportable  in  California,  New  York,  Pennsylvania,  and 
Washington. 

Ophthalmia  neonatorum. — Made  reportable  in  Indiana,  District  of  Columbia, 
New  Hampshire,  North  Dakota,  Utah,  and  Tennessee,  while  provision  for  the 
distribution  by  the  State  Board  of  Health  of  a  prophylactic  to  prevent  its 
occurrence  was  made  in  Massachusetts  and  Vermont,  thus  making  with  New 
York  and  Vermont  four  States  in  which  such  prophylactic  is  furnished  at 
public  expense. 

Rabies. — Made  reportable  in  California  and  Florida,  while  provision  was 
made  for  the  free  administration  of  Pasteur  treatment  to  indigent  persons 
in  Kansas,   Indiana,  and   Virginia. 

Diphtheria. — Provision  for  the  free  supply  of  diphtheria  antitoxin  was  made 
in  the  laws  of  Connecticut,   Delaware,  and  Iowa. 

Venereal  Diseases. — Both  California  and  Colorado  require  in  recent  laws 
the  reporting  of  venereal  diseases,  this  being  the  first  action  of  this  nature 
in  the  United  States,  and  perhaps  in  America. 

Tuberculosis. — The  last  two  years  have  been  marked  by  more  or  less  com- 
prehensive legislation  in  practically  all  parts  of  the  Union  with  respect  to 
tuberculosis. 

In  addition  to  the  appropriations  made  for  the  support  of  sanatoria  already 
in  existence,  appropriations  for  new  State  sanatoria  were  made  in  1911  in 
Connecticut,  Kansas,  Montana,  Nebraska,  North  Dakota,  Texas,  and  West 
Virginia,  while  Missouri  made  provision  for  the  erection  of  district  tuber- 
culosis hospitals,  and  New  Jersey  and  Wisconsin  authorized  the  establishment 
by  the  counties  of  such  hospitals.  Appropriations  for  the  care  of  tuberculous 
patients  were  made  in  California,  Louisiana,  and  Porto  Rico,  and  for  educa- 
tional campaigns  in  California,  Massachusetts,  Mississippi,  New  Jersey,  and 
Vermont,  and  for  the  acquisition  of  tuberculosis  charts  for  use  in  the  schools 
in  Mississippi.  State  commissions  for  the  study  and  recommendation  of  the 
best  methods  to  combat  the  disease  were  created  by  law  in  Massachusetts, 
Missouri,  New  Jersey,  Minnesota,  Rhode  Island,  and  Vermont. 

Laws  relating  to  the  registration  of  cases  were  enacted  in  California, 
Mississippi,  New  Jersey  (in  this  State  a  more  satisfactory  law  being  sub- 
stituted for  the  old  one),  New  Hampshire,  and  Rhode  Island,  while  their 
registration  was  also  required  in  the  new  regulations  issued  by  the  State 
health  authorities  in  Virginia  and  Porto  Rico;  and  the  stipulation  that  the 
records  will  be  strictly  confidential  made  in  Wisconsin. 

In  Ohio  a  new  departure  was  made  by  authorizing  the  establishment  of 
separate  schools  for  children  suffering  with  tuberculosis.  A  New  Jersey  law 
forbade  expectoration  on  the  floors  or  walls  or  trolley  cars;  while  in  Wis- 
consin  expectoration  in  all  public  places  was  prohibited. 

Drinking    Cup. — An    organized    effort    to    suppress    the    promiscuous    use   of 


FIFTH    INTERNATIONAL  SANITARY  CONFERENCE.  123 

drinking  cups  in  public  places  was  made  with  the  result  that  during  the  year 
1911  laws  were  passed  prohibiting  their  use  in  Colorado,  Connecticut,  Idaho, 
Illinois,  New  Hampshire,  New  Jersey,  Massachusetts,  and  Vermont,  while 
regulations  against  them  were  also  issued  by  the  State  Boards  of  Health  in 
Kansas,  Louisiana,   Michigan,  Mississippi,  Oklahoma,  Oregon,  and  Wisconsin. 

The  use  of  roller  towels  was  forbidden  by  laws  in  Connecticut  and  Wis- 
consin, and  by  regulation  in  Kansas,  and  the  use  of  suction  shuttles  in  fac- 
tories in  Massachusetts. 

Vital  Statistics. — With  a  view  to  making  the  registration  of  births  and 
deaths  more  complete,  modifications  to  the  existing  laws  were  introduced  in 
Alabama,  Idaho,  Illinois,  Kansas,  Kentucky,  Massachusetts,  Minnesota,  Mon- 
tana, Nevada,  New  York,  North  Carolina,  Porto  Rico,  and  Rhode  Island. 
The  most  important  of  these  laws  are  those  of  Idaho,  Kansas,  Kentucky, 
Montana,  and  Nevada,  as  their  provisions  will  probably  capacitate  these  States 
for  admission  to  the  "registration  area"  of  the  United  States.  Only  minor 
changes  were  made  in  the  laws  of  Massachusetts,  Minnesota,  New  York,  and 
Rhode  Island,  States  which  already  belong  to  the  "registration  area."  The  law 
of  North  Carolina  extends  the  collection  of  birth  and  death  statistics  to  cities 
over  500  inhabitants  instead  of  1,000  as  formerly. 

Occupational  Diseases. — A  fair  start  towards  ascertaining  the  prevalence  of 
certain  diseases  in  various  occupations,  and  thus  evolve  remedies  to  avoid 
their  occurrence,  was  made  in  1911,  when  laws  requiring  the  reporting  of 
certain  diseases  of  occupation  was  passed  in  California,  Illinois,  Michigan, 
New  Jersey,  New  York,  and  Wisconsin.  These  laws  apply  mainly  to  those 
industries  in  which  poisonous  materials  or  other  dangerous  substances  arc 
handled  by  the  employees.  The  Illinois  law  has  the  widest  scope  of  all,  as  it 
also  requires  that  the  employers  shall  provide  approved  devices  and  methods 
for  the  prevention  of  the  diseases  in  question. 

Factory  Sanitation  and  Hygiene  of  Employees. — Further  protection  to  the 
health  of  employees  was  provided  by  laws  passed  in  Illinois,  Maryland,  Massa- 
chusetts, New  York,  and  Virginia,  in  which  provision  is  made  to  secure  the 
safety  and  sanitation  of  various  industries.  In  Kentucky,  New  York,  New 
Jersey,  Massachusetts,  Rhode  Island,  Maryland,  Pennsylvania,  South  Carolina, 
and  Illinois,  laws  were  enacted  regulating  the  employment  of  minors  and 
women. 

Poisons. — For  the  purpose  of  restricting  the  sale  of  poisons  or  narcotics, 
laws  were  enacted  in  California,  Illinois,  Indiana,  Massachusetts,  Mississippi, 
Montana,  New  York,  Ohio,  Oklahoma,  South  Carolina,  and  West  Virginia. 

Asexualization. — A  law  was  passed  in  Iowa  providing  for  the  sterilization 
of  degenerate  criminals,  thus  making  four  States  (California,  Connecticut, 
Indiana,  and  Iowa)   in  which  such  provision  is  in   force. 

School  Inspection. — A  number  of  States  passed  laws  for  the  medical  inspec- 
tion of  children  attending  the  public  schools.  These  are  Indiana,  New  York, 
Rhode  Island,  Utah,  Vermont,  and  West  Virginia. 

Hotel  Sanitation. — Regular  inspections  by  the  health  authorities  and  similar 
establishments  with  a  view  to  secure  the  maintenance  of  sanitary  conditions 
are  provided  for  in  recent  laws  of  Georgia,  Idaho,  Mississippi,  Oklahoma, 
and    Virginia. 

Tenement  Houses. — Regulation  of  the  tenement  houses  which  constitute 
chiefly  the  dwellings  of  the  poor  is  aimed  at  in  legislation  passed  in  California, 
Connecticut,  Kentucky,  and  New  York,  while  the  determination  of  insanitary 
dwellings,  and  as  such  unfit  for  human  habitation,  is  contemplated  in  a  Penn- 
sylvania law. 

Plumbing. — Examinations  for  plumbers  are  provided  in  the  laws  of  Mary- 
land, Ohio,  and  Pennsylvania,  while  their  examinations  are  placed  under  the 
control  of  the   State  Board  of  Health  in   Massachusetts. 

Nurses. — Laws  establishing  certain  requirements  for  nurses  and  compelling 
their  registration  were  passed  in  New  Jersey,  Maryland,  Vermont,  Idaho, 
and    Wisconsin. 

Pharmacy. — Changes  in  the  laws  governing  the  exercise  of  the  pharma- 
ceutical profession  were  enacted  in  Kentucky,  New  York,  Indiana,  Maryland, 
Rhode   Island,  Utah,   and   Vermont. 

Embalming. — The  provisions  for  the  licensing  of  embalmers  and  the  exercise 
of  their  calling  were  somewhat  amended  in  Maryland,  Vermont,  and  Wisconsin. 


124  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

Water  Supply. — A  number  of  laws  having  for  their  object  the  prevention 
of  water  pollution  were  passed  in  California,  New  Jersey,  Illinois,  Louisiana, 
Rhode  Island,  and  Wisconsin. 

Milk  Supply. — Provisions  to  prevent  the  contamination  of  milk  were  enacted 
in  Colorado,  Idaho,  Louisiana,  Massachusetts,  Montana,  New  Jersey,  New 
York,  Pennsylvania,  South  Dakota,  Utah,  Vermont,  and  Washington ;  laws 
requiring  the  enforcement  of  the  tuberculin  test  on  cattle  were  passed  in 
Maryland  and  Virginia. 

Food. — Various  amendments  to  the  food  laws  were  made  in  Georgia,  Illinois, 
Indiana,  Kansas,  Massachusetts,  Mississippi,  Montana,  New  Jersey,  Rhode 
Island,  South  Dakota,  Utah,  Wisconsin,  Wyoming,  California,  Pennsylvania, 
and  Vermont.  The  sanitation  of  food  establishments,  and  the  personal  hygiene 
of  employees  handling  or  selling  food  is  required  in  the  laws  passed  in  New 
Hampshire,  Rhode  Island,  Illinois,  and  Utah  (only  in  establishments  selling  or 
handling  meat  or  meat  products). 

FULFILLMENT    OF    RESOLUTIONS    ADOPTED    IN    PREVIOUS    CONFERENCES. 

The  delegation  of  the  United  States  to  the  Fourth  International  Sanitary 
Conference  reported  on  those  matters  of  special  import  relative  to  the  manner 
in  which  the  resolutions  of  previous  conferences  had  been  put  in  practice. 
It  remains  to  report  on  the  means  employed  in  the  United  States  and  its 
possessions  for  the  enforcement  of  the  resolutions  agreed  upon  at  the  last 
conference  held  in  San  Jose. 

With  respect  to  bilharziosis,  no  measures  of  protection  have  been  taken,  nor 
were  they  necessary,  since  the  disease  is  an  exotic  one  and  practically  never 
reported  in  the  continental  United  States. 

Rabies  has  been  made  the  subject  of  special  investigations,  and  certain  defi- 
nite measures  have  been  taken  for  its  control. 

The  disease  prevails  in  many  sections  of  the  country,  and  it  was  one  of 
the  subjects  for  consideration  at  a  conference  of  State  and  territorial  health 
authorities  held  in  Washington,  D.  C,  April  30,  1910.  As  a  result,  there  were 
adopted  certain  specific  recommendations  regarding  the  measures  necessary 
for  the  prevention  and  eradication  of  rabies,  which  recommendations  were 
subsequently  published  and  distributed  to  health  officers  throughout  the  coun- 
try. The  apparent  increase  of  rabies  in  the  United  States  rendered  necessary 
the  placing  of  antirabic  virus  at  the  disposal  of  persons  bitten  by  rabid 
animals,  and  on  April  29,  1908,  there  was  undertaken  the  preparation  and 
administration  of  antirabic  virus  at  the  Hygienic  Laboratory  at  Washington. 
Treatments  at  this  institution  are  administered  without  charge,  and  in  addition 
the  virus  is  sent  to  State  health  authorities  for  final  preparation  and  adminis- 
tration by  them.  During  the  fiscal  year  1910,  128  persons  were  treated  at  the 
Hygienic  Laboratory,  and  777  treatments  were  sent  out  to  the  health  authori- 
ties of  14  States.  Twelve  shipments  of  the  virus  were  made  to  the  Canal 
Zone. 

Measures  for  the  control  of  rabies,  to  be  effective,  must  be  State-wide  in 
their  application,  and  there  must  be  uniformity  of  executive  action  by  con- 
tiguous States   if  any  lasting  benefit  is  to  be  secured. 

In  the  absence  of  federal  law  for  the  treatment  and  care  of  lepers  these 
duties  devolve  upon  State  and  local  health  authorities.  Lepers  who  arrive 
at  quarantine  are,  of  course,  amenable  to  the  maritime  quarantine  regulations. 
Any  American  sailor  who  may  be  afflicted  with  the  disease  is  entitled  to  treat- 
ment, but  other  persons  are  cared  for  by  the  localities  in  which  they  live. 
Provision  has  been  made  by  the  national  government,  however,  for  continuous 
and  systematic  investigations  of  leprosy,  and  these  are  being  conducted  at 
the  national  Leprosy  Investigation  Station  in  Hawaii.  The  leprosy  bacillus 
has  been  grown  in  symbiosis  and  in  pure  culture.  The  disease  has  been  trans- 
mitted to  lower  animals,  and  attempts  have  been  made  to  obtain  not  only  a 
vaccine  but  a  curative  serum.     These  attempts  give  some  promise  of  success. 

The  continued  absence  of  typhus  fever  from  the  United  States  has  rendered 
unnecessary  the  taking  of  any  special  measures  against  the  disease.  Realizing 
its  importance,  however,  and  the  possibility  of  its  introduction,  two  officers 
of  the  Service  were  sent  to  Mexico  City  in  November,  1909,  to  study  the 
etiology  and  mode  of  transmission  of  the  typhus   fever  prevailing  there,  and 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  125 

to  determine  its  similarity,  if  any,  to  Rocky  Mountain  Spotted  Fever.  These 
officers  found  from  their  studies  that  the  disease  was  not  identical  with  Rocky 
Mountain  Spotted  Fever,  but  probably  identical  with  Old-World  typhus  fever. 
They  succeeded  in  producing  the  disease  in  two  species  of  monkeys,  and  found 
that  it  is  not  contagious  in  the  ordinary  sense  of  the  word,  but  is  conveyed 
by  means  of  the  body  louse. 

Since  the  last  international  conference,  important  measures  have  been  taken 
in  the  United  States  for  the  prevention  and  eradication  of  hookworm  disease. 
The  new-world  type  of  this  organism  having  been  discovered  by  Professor 
C.  W.  Stiles,  in  1902,  it  has  been  the  subject  of  continuous  investigations  in 
the  Division  of  Zoology  of  the  Hygienic  Laboratory  since  that  time.  At  the 
same  time,  a  campaign  had  been  carried  on  with  the  result  that  the  public 
was  aroused  to  the  importance  of  the  disease,  both  from  economic  and  public 
health  standpoints,  and  in  October,  1909,  a  private  citizen  announced  the  gift 
of  one  million  dollars  to  be  used  for  the  eradication  of  hookworm  disease. 
The  administration  of  this  munificent  fund  was  placed  in  the  hands  of  a  board 
of  trustees,  and  matters  have  been  so  conducted  as  to  bring  about  thorough 
co-operation  between  federal,  State  and  municipal  sanitary  authorities,  organi- 
zations, and  private  individuals.  The  State  is  recognized  as  the  unit  of 
organization.  The  board  of  trustees  convinces  itself  of  the  existence  of  the 
disease  within  a  State,  and  the  State  board  of  health  then  appoints  an  officer 
who  takes  general  charge  of  the  work  of  eradication  and  appoints  assistants. 
It  will  thus  be  seen  that  the  actual  work  is  carried  on  under  the  supervision 
of  the  State  health  authorities.  Funds  are  made  available  from  the  gift 
mentioned  above,  and  the  federal  government  acts  in  an  advisory  capacity  and 
conducts  investigations  necessary  to  the  success  of  the  campaign. 

Through  public  documents  announcement  has  been  made  of  the  recommen- 
dations of  the  last  conference  with  respect  to  the  employment  of  necessary 
measures  to  secure  the  effective  sanitation  of  seaports  for  the  prevention  of 
plague,  cholera,  and  yellow  fever.  A  special  bulletin  was  issued  on  the  subject 
of  rats  in  relation  to  the  public  health,  and  special  attention  was  invited  to 
the  necessity  of  rat-proofing  buildings.  In  other  words,  it  was  urged  that  the 
rat  must  be  builded  out  of  existence.  The  extent  of  this  work  and  the 
results  following  it  in  San  Francisco  and  elsewhere  on  the  Pacific  Coast  will 
be  referred  to  in  the  special  report  on  antiplague  measures  which  is  to  follow. 
In  the  above-mentioned  bulletin,  attention  was  also  invited  to  the  importance 
of  the  use  of  properly  constructed  garbage  cans.  The  providing  of  such  cans 
and  the  enforcement  of  regulations  relating  thereto  devolves  entirely  on  private 
citizens  and  municipal  authorities,  and  in  San  Francisco  and  adjoining  cities 
in  which  plague  has  prevailed  in  the  past,  such  cans  have  been  provided  in 
large  numbers. 

Properly  equipped  laboratories  for  the  detection  of  plague  infection  among 
rats  have  been  maintained  at  the  more  important  seaports  on  the  Pacific  Coast 
and  Hawaii,  such  as  Seattle,  San  Francisco,  Los  Angeles,  and  Honolulu,  and 
arrangements  are  contemplated  which  will  extend  this  laboratory  service  to 
other  ports  as  occasion  may  demand. 

In  the  vicinity  of  some  cities,  such  as  New  Orleans,  active  crusades  have 
been  conducted  for  the  extermination  of  mosquitoes,  and  in  certain  of  the 
States,  as  New  Jersey,  there  exist  statutes  which  provide  for  the  determination 
of  mosquito  breeding  areas  and  their  proper  drainage. 

The  measures  contemplated  in  the  third  resolution  adopted  by  the  last 
conference  are  recognized  by  municipal  authorities  generally  as  being  of  fun- 
damental importance,  and  in  general  they  are  already  made  the  basis  of 
sanitary  administration  in  seaports  and  cities  of  the  country. 

In  conformity  with  the  fourth  resolution,  and  as  had  previously  been  decided 
upon,  there  was  adopted  the  following  quarantine  regulation : 

"Vessels  engaged  in  trade  from  ports  infected  with  plague  shall  have  such 
measures  taken  as  will  free  them  from  rats  not  less  than  once  every  six 
months.     This  is  best  done  by  fumigation  when  the  vessel  is  empty." 

It  is  now  recognized  that  rodents  are  the  all-important  agents  in  the  trans- 
mission of  plague  in  international  commerce,  and  that  the  most  essential  anti- 
plague  measure  is  the  freeing  of  ships  of  rodents.  Studies  are  accordingly 
being  made  to  determine  the  best  method  of  accomplishing  this  without  the 
destruction  of  cargo. 


126  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

The  provisions  mentioned  in  the  fifth  resolution  have  long  been  embodied  in 
the  United  States  quarantine  regulations,  and  the  edition  of  these  regulations, 
revised  October,  1910,  are  entirely  in  conformity  with  the  spirit  of  the 
resolution. 

The  dissemination  of  information  regarding  sanitation  and  the  public  health 
is  a  peculiar  function  of  the  federal  government,  and  as  such  has  been  as 
fully  performed  as  available  appropriations  would  permit.  As  an  example,  it 
may  be  stated  that  during  the  fiscal  year  1910  over  400,000  copies  of  sanitary 
and  public  health  bulletins  were  distributed  by  the  Public  Health  and  Marine 
Hospital  Service.  Other  bureaus  and  divisions  of  the  government  likewise 
distributed  pamphlets,  some  of  which  undoubtedly  had  an  indirect  bearing  on 
the  public  health.  In  order  to  discharge  more  fully  this  function,  and  to 
conform  in  larger  measure  to  the  eighth  resolution,  representations  have  been 
made  for  greater  facilities  for  the  publication  and  distribution  of  public 
health  literature. 

The  models  of  sanitary  documents  approved  by  the  last  conference  and 
mentioned  in  its  ninth  resolution  have  been  adopted,  and  are  used  in  quaran- 
tine  practice. 

On  account  of  the  cholera  situation,  which  during  the  past  summer  has  been 
acute,  it  was  impracticable  to  conform  to  that  part  of  the  tenth  resolution 
which  recommends  to  the  government  represented  that  for  future  sanitary 
conferences  there  be  nominated  delegates  who  have  assisted  at  previous  con- 
ferences. It  may  be  stated,  however,  that  the  officers  designated  as  delegates 
on  behalf  of  the  United  States  to  the  present  conference  are  sanitary  author- 
ities of  the  highest  character  and  charged  with  most  responsible  duties  in  the 
protection  of  the  public  health. 

With  respect  to  the  twelfth  and  thirteenth  resolutions  encouragement  has 
been  given  by  the  federal  government  to  original  investigations  in  parasitology 
and  tropical  medicine.  Studies  of  the  former  subject  are  being  made  by 
officers  of  the  government,  and  systematic  studies  of  tropical  hygiene  by  private 
institutions  are  being  arranged  or  carried  on.  As  an  example,  may  be  men- 
tioned the  contemplated  establishment  of  a  School  of  Tropical  Medicine  at 
Tulane  University,  at   New  Orleans,  La. 

Finally,  it  may  be  stated  that  commendable  progress  has  been  made  in  the 
United  States  during  the  past  two  years  by  sanitary  authorities  generally,  not 
only  in  the  execution  of  necessary  measures  laid  down  by  the  last  conference, 
but  by  means  of  investigations  into  the  causes,  methods  of  transmission,  and 
measures  necessary  for  the  prevention  and  eradication  of  communicable 
diseases. 

ORGANIZATION   AND   WORK   OF  THE   COMMITTEE   IN   THE   UNITED   STATES   TO  REPORT   IN 
CONNECTION    WITH    THE   INTERNATIONAL    SANITARY   BUREAU    OF    WASHINGTON. 

In  conformity  with  the  plan  adopted  at  the  Fourth  International  Sanitary 
Conference,  it  became  necessary  to  submit  the  names  of  three  gentlemen  who 
would  constitute  a  committee  in  the  United  States  to  act  as  delegates  of  the 
International  Sanitary  Bureau  of  Washington,  and  to  form  part  of  the  Inter- 
national Sanitary  Information  Committee  of  the  American  Republics.  The 
names  submitted  by  Surgeon-General  Wyman  were  those  of  officers  of  his 
Bureau  who  were  then  and  had  previously  been  engaged  in  the  collection  and 
preparation  of  sanitary  information  for  distribution. 

In  the  absence  of  the  Surgeon-General,  and  by  reason  of  seniority,  Assistant 
Surgeon-General  A.  H.  Glennan  was  at  times  in  temporary  charge  of  the 
Bureau  of  Public  Health.  Assistant  Surgeon-General  J.  W.  Kerr  has  adminis- 
trative supervision  over  all  scientific  research  relating  to  public  health  ques- 
tions, and  Assistant  Surgeon-General  J.  W.  Trask  has  charge  of  the  Division 
relating  to  the  collecting  of  sanitary  reports  and  statistics.  The  work  repre- 
sented by  these  two  latter  Divisions  are  published  in  the  form  of  Hygienic 
Laboratory  Bulletins.  Public  Health  Bulletins,  and  Public  Health  Reports. 
Copies  of  all  of  these  publications,  when  issued,  are  furnished  to  diplomatic 
representatives  of  the  American  Republics  at  Washington,  copies  are  sent  to 
the  Pan  American  Union,  and  access  is  had  to  them  by  the  membership  of 
the  International  Sanitary  Bureau  of  Washington. 

It  would  appear  that  the  plan  devised  and  adhered  to  by  successive  inter- 


FIFTH   INTERNATIONAL  SANITARY   CONFERENCE.  127 

national  sanitary  conferences  to  provide  for  the  collection  and  dissemination 
of  information  respecting  health  conditions  in  the  Western  Hemisphere  is  a 
wise  one  and  deserving  of  further  elaboration.  The  plan  contemplates  a 
committee  of  three  physicians  in  each  country  to  collaborate,  and  their  efforts, 
together  with  the  regular  discharge  of  duties  of  sanitary  officials,  should  result 
in  the  prompt  collection  of  accurate  data. 

The  names  of  the  committees  appointed  by  the  several  countries  are  included 
in  the  report  of  the  Fourth  International  Conference  held  in  Costa  Rica,  and 
it  is  hoped  at  this  meeting  in  Santiago  the  work  of  these  committees  appointed 
by  the  different  countries  may  be  systematized  so  that  the  reports  may  be 
gathered  regularly  and  transmitted,  a  part  through  the  Bureau  of  Information 
of  Montevideo,  and  a  part  direct  to  the  Sanitary  Bureau  at  Washington. 
According  to  the  statement  of  President  Ulloa  at  the  Fourth  Conference  in 
San  Jose  de  Costa  Rica  countries  north  of  Ecuador  should  report  to  the 
Bureau  at  Washington,  those  to  the  south  to  the  Bureau  at  Montevideo. 

The  United  States,  through  its  Public  Health  Service  and  the  bulletins  that 
it  issues,  is  able  to  disseminate  pertinent  information  affecting  its  own  country, 
and  many  of  these  bulletins  are  sent  to  adjoining  countries. 

The  Chief  Sanitary  Officers  of  any  country  here  represented  who  is  not 
on  the  mailing  list  and  does  not  receive  the  bulletins  will  be  placed  thereon 
upon  request.  Many  of  these  bulletins  have  heretofore  been  sent  to  the  other 
Republics  through  their  diplomatic  representative  in  Washington,  but  a  direct 
request  from  the  Chief  Sanitary  Officer  of  each  country  would  meet  with  a 
favorable  response  for  the  regular  mailing  of  certain  of  these  bulletins.  In 
this  connection  mention  should  be  made  of  the  monthly  bulletin  of  the  Inter- 
national Office  of  Hygiene  of  Paris  published  in  the  French  language.  They 
contain  most  valuable  information  from  all  countries  throughout  the  world. 
The  bulletins  are  now  available  to  those  countries  which  contributed  to  the 
support  of  the  International  Office  of  Hygiene  of  Paris.  The  latest  informa- 
tion concerning  health  activities  in  the  United  States  as  well  as  in  other 
countries  are  contained  in  these  bulletins.  It  would  be  well  if  each  country 
would  become  contributory  to  this  office  in  Paris  so  that  these  bulletins  would 
be  transmitted  regularly  to  the  principal  sanitary  authorities  in  each  of  the 
Republics. 

SANITATION    OF   CITIES    AND    SEAPORTS. 

American  cities  enjoy  the  greatest  amount  of  decentralization;  and  excepting 
certain  restrictions  on  taxation  and  indebtedness  imposed  upon  them  by  their 
charters  or  the  general  laws,  they  are  sole  arbiters  in  all  matters  pertaining 
to  internal  improvements.  There  are  of  course  certain  sanitary  requirements 
which  they  must  observe,  as  otherwise  the  State  authorities  are  usually  empow- 
ered to  intervene  and  take  charge  of  the  health  administration,  an  action 
which  would  hurt  the  business  interests  of  the  city,  and  to  which  all  com- 
munities are  averse.  In  the  case  of  epidemics,  defective  sanitary  conditions, 
or  impure  water  supply,  liable  to  cause  disease,  the  State  Board  of  Health  or 
the  Federal  Public  Health  Service  sends  on  request  experts  to  investigate 
the  matter,  determine  the  exact  conditions  responsible  for  it,  and  suggest 
remedies  for  their  improvement  or  prevention.  These  requests  are  frequently 
received  from  various  parts  of  the  country,  and  as  a  result  of  the  reports 
made  by  the  officers  conducting  the  investigation,  sanitary  works  are  often 
undertaken  by  the  cities  with  a  view  to  securing  better  water  supply,  disposal 
of  sewage,  etc. 

Although  the  Federal  Government  purposely  abstains  from  interference  in 
local  affairs,  the  enormous  amount  of  national  property  scattered  all  over  the 
country  in  the  form  of  quarantine  stations,  marine  hospitals,  naval  reserva- 
tions, custom  houses,  army  posts,  post  offices,  etc.,  obliges  the  national  author- 
ities, outside  of  other  considerations,  to  watch  closely  local  health  conditions, 
and  gives  them  at  the  same  time  an  excellent  opportunity  to  exercise  a  benef- 
icent influence  on  the  health  affairs  of  most  cities.  This  influence  is  due  to 
the  high  sanitary  and  hygienic  standards  maintained  by  the  Federal  Govern- 
ment in  the  grounds  or  reservations  under  its  control,  and  also  to  the  fear 
that  if  proper  sanitary  requirements  are  not  enforced,  such  federal  property 
as  is  located  in  the  city  may  be  appropriated  to  other  purposes. 


128  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

In  a  number  of  States,  cities  are  required  to  provide  such  modern  facilities 
as  sewerage  systems,  adequate  water  supply,  drainage  facilities,  etc.,  the  expense 
to  be  met  by  taxes  or  bonds  to  be  approved  by  the  people  at  special  elections, 
or  distributed,  pursuant  to  the  provisions  of  the  law,  between  the  public 
treasury  and  the  owners  of  the  property  benefited.  Such  improvements  are 
going  on  all  the  time  in  practically  every  part  of  the  country.  Vast  work  in 
this  line  has  been  done  in  the  most  important  cities,  such  as  Baltimore,  New 
Orleans,  New  York,  Seattle,  and  San  Francisco.  To  further  accelerate  this 
movement,  laws  have  been  passed  in  some  States,  as  in  Pennsylvania,  requiring 
all  cities  in  the  State  to  erect  plants  for  the  disposal  of  their  sewage  in  a 
fixed  number  of  years.  In  those  States  with  large  centers  of  population  hardly 
a  legislative  session  goes  by  without  the  enactment  of  some  law  aimed  at  safe- 
guarding the  water  supply,  compelling  the  adoption  of  scientific  systems  of 
sewage  disposal,  or  appointing  commissions  to  study  any  existing  unsanitary 
conditions,  and  make  recommendations  for  their  amelioration. 

As  some  cities  derive  their  water  supply  from,  or  discharge  their  sewage 
into,  interstate  or  international  waters,  which  are  admittedly  under  federal 
control,  there  is  a  strong  probability  that  the  national  congress  may  adopt 
measures  to  prevent  the  pollution  of  these  waters,  thus  helping  the  cause  of 
the  many  communities  which  are  now  struggling  so  persistently  for  better 
sanitary  conditions. 

On  the  whole  there  is  steady  improvement  in  the  United  States  in  the  matter 
of  sanitation  of  urban  centers,  the  results  of  which  will  undoubtedly  be 
reflected  in  lower  morbidity  and  mortality  rates. 

PROPHYLACTIC     MEASURES     TAKEN     AGAINST     THOSE     DISEASES     SPECIFICALLY     MEN- 
TIONED  AND    PROVIDED    FOR    IN    THE    SANITARY    CONVENTION    SIGNED 

ad  referendum,  Washington,  October  14,  1905. 

In  conformity  with  the  sixth  topic  contained  in  the  provisional  program,  it 
is  necessary  to  review  the  present  status  as  affects  the  United  States  of  those 
diseases  specifically  mentioned  in  the  International  Sanitary  Convention  signed 
at  Washington,  October  14,  1905.  These  diseases  are  plague,  cholera  and 
yellow  fever.  As  is  well  known,  both  plague  and  cholera  are  making  pandemic 
invasions  of  the  earth,  while  yellow  fever,  on  the  other  hand,  has  receded  until 
it  may  be  stated  that  it  has  been  less  prevalent  during  the  last  two  or  three 
years  than  for  any  equal  period  in  a  quarter  of  a  century.  No  detailed  descrip- 
tion will  therefore  be  given  of  the  measures  taken  against  yellow  fever,  and 
particularly  since  report  is  subsequently  to  be  made  on  the  broad  subject  of 
immunity  to  this  disease. 

It  remains  to  discuss  both  plague  and  cholera,  which  diseases  within  the  last 
two  years  have  been  of  great  interest,  not  only  to  the  United  States,  but  to 
practically  all  other  countries  in  the  Western  Hemisphere.  The  continued 
advance  of  these  diseases  is  sufficient  to  attest  the  wisdom  of  the  action  taken 
at  preceding  conferences  for  their  prevention,  and  to  invite  further  interna- 
tional co-operation  for  their  eradication. 

plague. 

It  was  stated  in  the  report  of  the  Delegates  of  the  United  States  at  the 
Fourth  International  Sanitary  Conference  that  measures  against  plague  were 
being  continued  on  the  Pacific  Coast  by  the  Public  Health  and  Marine  Hos- 
pital Service.  These  measures  have  been  continuously  carried  on  since  that 
report  was  made,  with  the  result  that  no  cases  of  human  plague  have  occurred 
in  San  Francisco  since  February,  1908,  and  no  cases  have  been  infected  in 
Oakland  since  July  17,  1908.  Only  four  cases  have  occurred  in  this  period, 
and  these  were  in  rural  districts.  The  last  case  of  rat  plague  in  San  Fran- 
cisco was  found  October  23,  1908,  and  in  Oakland,  Cal.,  December  1,  1908. 
At  Seattle,  Wash.,  no  case  of  human  plague  has  occurred  since  October  25, 

1907,  and  but  two  cases  of  rat  plague  have  been  found  since  September  26, 

1908.  These   rats   were   found,   one   February   8,   1910,   and   the   other   August 
26,   1911. 

Anti-plague  measures  have  been  continued  in  these  cities  and  are  being 
continued  at  the  present  time  even  though  no  cases  of  human  or  rodent  plague 
have  been  discovered   except   as   above   mentioned.    The   measures   have  been 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  129 

continued  for  the  purpose  of  determining  whether  plague  had  appeared  or  was 
likely  to  reappear  among  rodents,  and  were  made  especially  necessary  in  San 
Francisco  and  the  bay  cities  by  the  prevalence  of  plague  among  the  common 
ground  squirrels  of  California,  the  first  infected  squirrel  having  been  found 
in  Contra  Costa  County  in  August,  1908.  Since  the  discovery  of  this  squirrel 
a  continuous  campaign  of  investigation  and  eradication  has  been  carried  on 
for  the  double  purpose  of  determining  to  what  extent  the  infection  has  spread, 
and  to   destroy  infected  squirrels  as   far  as  possible. 

Squirrel-free  zones  have  been  maintained  around  the  cities  of  San  Fran- 
cisco, Oakland,  Berkeley,  and  Alameda,  and  have  averaged  from  a  mile  or 
two  to  several  miles  in  width.  Camps  of  instruction  have  been  maintained 
upon  these  zones  for  the  purpose  of  instructing  new  employees  in  the  methods 
to  be  used  in  squirrel  destruction,  and  also  for  the  purpose  of  instructing 
county  authorities,  ranch  owners,  farmers,  and  other  individuals  who  desire 
to  avail  themselves  of  the  opportunities  thus  afforded. 

The  investigations  as  to  the  prevalence  of  squirrel  plague  have  extended 
over  45  counties  of  the  State  of  California,  and  investigations  have  been  made 
in  several  counties  of  Nevada  and  Oregon  as  well.  No  infection  has  been 
found  in  these  latter  named  States. 

During  the  past  two  years  infection  has  been  found  among  squirrels  in 
11  counties  of  the  State  of  California.  During  the  past  year,  however,  no 
infection  has  been  found  in  4  of  the  counties  that  were  previously  infected, 
leaving  7  counties  infected  at  present. 

In  September,  1910,  a  systematic  campaign  against  squirrels  was  begun  in 
the  following  manner :  A  portion  of  the  force  was  used  in  the  maintenance 
of  squirrel-free  zones  and  for  the  purpose  of  destroying  known  foci  of 
infection.  Another  portion  was  sent  further  afield  for  the  purpose  of  deter- 
mining to  what  extent  the  infection  had  spread,  and  for  the  discovery  of 
new  and  unknown  foci  of  infection.  This  work  has  been  practically  com- 
pleted for  several  months  and  a  general  campaign  of  squirrel  eradication  is 
now  being  carried  on. 

On  March  13,  1909,  the  Legislature  of  the  State  of  California  passed  an  act 
which  makes  it  incumbent  upon  property  owners  throughout  the  State  to 
begin  in  good  faith  the  destruction  of  all  squirrels  on  their  property,  and  the 
State  Board  of  Health  is  authorized  to  make  inspection  to  determine  whether 
squirrels  are  present  or  not.  When  the  presence  of  squirrels  is  reported  by 
agents  of  the  State  Board  of  Health,  notice  is  served  upon  the  property  owner 
to  begin  work.  If  work  is  not  begun  within  a  reasonable  time  the  State 
Health  Officer  or  the  local  Health  Officer  of  the  county  in  which  the  property 
lies  proceeds  to  exterminate  the  squirrels  and  the  cost  of  this  work  then 
becomes  a  lien  upon  the  property. 

The  officer  of  the  Public  Health  and  Marine  Hospital  Service  in  charge  of 
plague  suppressive  measures  in  California  has  perfected  an  arrangement  with 
the  State  and  county  authorities  by  which  a  certain  number  of  inspectors  are 
appointed  by  the  latter.  These  county  inspectors  work  in  conjunction  with 
the  employees  of  the  Federal  Government  and  are  under  the  direction  of  the 
Service  Officer. 

Quite  a  number  of  counties  have  joined  this  movement  and  have  employed 
inspectors,  and  as  a  result  a  joint  Federal  and  County  inspection  is  under  way. 
Much  interest  is  being  manifested  in  the  work  by  all  parties  concerned  and 
favorable  results  are  expected. 

Since  the  report  to  the  Fourth  International  Sanitary  Conference  4  cases 
of  plague  have  occurred.  All  these  cases  were  infected  from  ground  squirrels 
and  no  spread  has  resulted  from  any  case.  During  the  year  ending  July  1, 
1910,  116,515  rats  were  collected  and  examined  and  none  found  infected. 
One  hundred  and  thirteen  thousand  six  hundred  and  fifty-five  were  caught  and 
examined  and  354  were  found  infected.  During  the  year  ending  July  1,  1911, 
127,948  rats  were  caught  and  examined  and  none  were  found  infected;  126,125 
squirrels  were  caught  and  examined  and  55  were  found  infected.  The  reason 
so  few  infected  squirrels  were  found  during  the  year  ending  July  1,  1911,  is, 
that  the  most  of  the  work  during  the  year  was  in  the  nature  of  a  recon- 
naissance to  determine  how  far  the  infection  had  spread.  Now  that  eradica- 
tion work  is  fairly  under  way,  it  is  expected  that  the  number  of  infected 
squirrels  found  will  be  materially  increased.  In  fact,  from  July  1,  1911,  to 
September  2,  1911,  78  infected  squirrels  have  been  found. 


130  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

The  fact  that  so  few  human  cases  of  plague  have  occurred  during  the  past 
two  years,  considering  the  extent  of  the  infection  in  California,  is  very 
encouraging,  as  is  also  the  fact  that  the  extent  to  which  infection  has  spread 
is  known. 

A  squirrel-free  zone  is  being  created  at  the  present  time  on  the  border  of 
the  infected  area  in  order  to  check  its  further  spread,  and  inasmuch  as  the 
efficacy  of  these  zones  has  been  proven  in  the  case  of  San  Francisco  and  the 
other  cities  there  is  reason  to  believe  that  the  free  zone  in  the  rural  district 
will  be  equally  efficacious.  This  latter  zone  was  made  necessary  for  the 
following  reasons : 

As  is  well  known  the  Sierra  Nevadas  are  a  large  range  of  mountains  which 
traverse  in  a  general  northerly  and  southerly  direction  the  eastern  part  of  the 
State  of  California;  the  common  ground  squirrel  of  California  is  found  as  far 
up  as  7,500  feet  elevation,  but  does  not  extend  to  a  higher  point,  the  average 
height  of  the  mountains  being  probably  10,000  feet.  These  mountains  were 
therefore  considered  as  more  or  less  of  a  natural  barrier.  Later,  however, 
investigation  has  shown  that  there  are  several  passes  through  these  moun- 
tains, the  elevations  of  which  are  less  than  the  7,500  feet  mentioned,  and  the 
squirrels  continue  through  these  passes  and  connect  with  the  squirrels  on  the 
eastern  side.  Prior  to  December,  1910,  the  San  Joaquin  River  had  been  con- 
sidered a  natural  barrier  to  the  spread  of  the  disease  among  squirrels  on 
account  of  its  size  and  on  account  of  the  fact  that  large  and  extensive  swamps 
are  present  on  both  sides  of  the  river,  but  in  December,  1910,  infected  squirrels 
were  found  on  the  east  side  of  this  river  at  two  points,  so  that  the  river  can 
no  longer  be  so  considered,  and  the  establishment  and  maintenance  of  the 
squirrel-free  zone  above  mentioned  was  decided  upon  as  the  best  means  of 
preventing  the  spread  of  the  disease  further  to  the  east. 

In  order  to  prevent  the  further  importation  of  plague  into  the  United  States 
and  to  avoid  all  interruption  of  commerce,  officers  of  the  Public  Health  and 
Marine  Hospital  Service  are  detailed  to  Guayaquil,  La  Guaira,  and  to  ports  of 
Japan  and  China.  These  officers  maintain  a  close  supervision  on  all  ships 
bound  for  the  United  States,  and  at  frequent  intervals  fumigate  vessels  bound 
for  the  United  States  with  sulphur  for  the  destruction  of  rats  and  the  other 
vermin  aboard.  The  quarantine  laws  and  regulations  of  the  United  States 
as  revised  in  October,  1910,  state  in  section  112,  as  follows: 

"Vessels  engaged  in  trade  from  ports  infected  with  plague  shall  have  such 
measures  taken  as  will  free  them  from  rats  not  less  than  once  in  every  six 
months.     This  is  best  done  by  fumigation  when  the  vessel  is  empty." 

With  this  regulation  as  a  basis  there  has  been  inaugurated  what  is  known  as 
a  "rat  quarantine,"  and  all  quarantine  stations  of  the  Service  have  been  directed 
to  report  to  the  Bureau  at  Washington  the  number  of  vessels  which  ply 
between  plague-infected  ports  and  ports  of  the  United  States,  and  are  directed 
to  fumigate  these  vessels  for  the  destruction  of  rats  and  vermin  at  least  once 
every  six  months,  and  oftener,  if  practicable. 

Experience  of  several  years  in  the  fumigation  of  vessels  in  the  Philippines 
has  shown  that  if  vessels  are  fumigated  regularly  at  least  once  every  six 
months,  rats  and  vermin  will  be  maintained  at  a  low  minimum,  due  to  the 
periodical  destruction  of  most  of  them,  and  also  due  to  the  fact  that  rats  will 
not  board  vessels  so  treated. 

The  progress  of  plague  throughout  the  world  has  been  carefully  followed 
during  the  last  two  years  and  necessary  precautions  have  been  taken  to 
prevent  the  entrance  of  the  disease.  The  occurrence  of  several  cases  of 
human  plague  in  the  county  of  Suffolk,  England,  the  discovery  that  plague 
is  endemic  among  the  rodents  of  that  vicinity,  and  the  discovery  of  plague 
among  rats  in  Wapping,  a  part  of  the  port  of  London,  are  matters  of  interest 
that  are  now  engaging  the  attention  of  the  Public  Health  and  Marine  Hospital 
Service  for  the  purpose  of  determining  what  influence  or  bearing  these  occur- 
rences will  have. 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  131 

CHOLERA. 

The  delegation  of  the  United  States  to  the  Fourth  International  Sanitary 
Convention  of  American  Republics  reported  on  the  world  distribution  of 
cholera  and  the  measures  which  were  being  taken  by  the  United  States  Public 
Health  and  Marine  Hospital  Service  against  its  introduction.  That  report 
covered  the  period  ending  June  30,  1909,  and  it  is  now  desired  to  review  the 
cholera   situation   from  that  time  to  the   end  of  the   fiscal  year   ending  June 

CHOLERA   IN   RUSSIA. 

During  the  summer  of  1909  cholera  was  distributed  over  a  wide  area,  the 
city  and  government  of  St.  Petersburg  and  the  southern  governments  suffering 
the  most.  In  St.  Petersburg  there  were  more  than  6,000  cases  and  over  2,000 
deaths.  The  disease  prevailed  in  all  parts  of  the  city  and  cholera  bacilli  were 
found  in  the  water  of  the  River  Neva,  from  which  the  municipal  water  supply 
is  taken.  With  the  approach  of  winter  there  was  a  subsidence  in  the  disease, 
and  from  January  29,  1910,  to  May  8,  1910,  no  cases  were  reported.  When 
the  disease  reappeared,  the  Bachmut  province  was  first  attacked,  and  from 
that  point  cholera  spread  over  European  Russia,  attacking  216,796  persons,  of 
whom  100,982  died,  in  the  period  from  May  8,  1910,  to  February  4,  1911. 
Cold  weather  again  brought  a  respite  from  the  disease  until  April  21,  1911, 
when  cholera  again  appeared  in  Russia.  From  that  date  until  September  11, 
1911,  1,045  cases  and  579  deaths  have  been  reported. 

CHOLERA    IN    GERMANY. 

An  July  21,  1909,  an  American  traveling  in  Europe  died  of  cholera  at 
Konigsberg,  Germany.  In  September  of  the  same  year  a  fatal  case  occurred 
in  Pakalisne.  near  Russ,  in  eastern  Prussia.  On  September  22d,  another  fatal 
case  was  reported  from  the  town  of  Stolzenhagen,  25  miles  north  of  Stettin. 
In  October,  November,  and  December  cases  were  reported  at  various  places  in 
East  Prussia,  but  on  December  30,  1909,  Germany  was  officially  declared  free 
of  cholera.  Forty-four  cases  occurred  during  the  outbreak.  On  June  23, 
1910,  a  Russian  immigrant  from  the  Warsaw  district  died  of  cholera  at  the 
immigrant  inspection  station  at  Ruhleben,  near  Berlin.  On  June  27th  another 
case  occurred  among  immigrants,  and  in  September  cases  occurred  in  Marien- 
burg  and  its  suburbs.  The  last  cases  reported  from  Germany  occurred  on 
October  9,  1910,  since  which  time  no  cases  have  been  reported  in  that  empire. 
Thirty-three  cases  and  sixteen  deaths  were  reported  during  the  1910  outbreak. 

CHOLERA   IN    SWEDEN. 

On  August  12,  1909,  a  case  of  cholera  occurred  at  Stockholm,  Sweden,  in 
the  person  of  a  traveler  who  had  arrived  by  steamship  from  St.  Petersburg 
on  August  10th.  This  is  the  only  case  which  has  been  reported  from  Sweden 
in  the  present  pandemic. 

CHOLERA    IN    THE    NETHERLANDS. 

Two  cases  of  cholera  were  reported  at  Rotterdam  on  August  20,  1909.  The 
local  health  authorities  immediately  inaugurated  vigorous  measures  to  prevent 
the  spread  of  the  disease.  In  all,  thirty- four  cases  and  fifteen  deaths  occurred 
up  to  September  14,  1909,  when  Rotterdam  was  officially  declared  free  from 
cholera.  In  1910,  one  case  occurred  at  Rotterdam  on  board  a  vessel  from 
Russia,  and  since  that  time  no  cases  have  been  reported  from  that  city. 
During  the  1909  outbreak  the  disease  appeared  in  sporadic  form  at  many  places 
in  Holland,  and  had  it  not  been  for  the  prompt  and  efficient  measures  which 
were  promptly  taken  at  the  infected  places,  a  more  serious  outbreak  would 
have  occurred.  The  wide  dissemination  of  the  disease  may  be  accounted  for 
by  the  presence  of  cholera  carriers,  of  which  a  number  were  found. 

CHOLERA    IN    BELGIUM. 

Nine  cases  of  cholera  with  six  deaths  were  reported  between  October  26 
and  30,  1909,  at  Boom,  a  town  of  about  17,000  inhabitants,  situated  10  miles 
from  Antwerp.     Since  that  time  no  cases  have  been  reported  from  Belgium. 


132  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 


CHOLERA   IN    THE    PHILIPPINES. 

Cholera  was  present  in  the  Philippines  throughout  1909  and  1910,  but  a 
determined  effort  was  made  to  discover  and  isolate  every  case,  and  so  vigor- 
ously has  this  been  prosecuted  that  no  cases  were  reported,  either  from  Manila 
or  the  provinces  for  the  first  quarter  of  1911.  A  case  from  Amoy,  China,  was 
apprehended  at  the  Mariveles  quarantine  station  May  25,  1911. 

CHOLERA    IN    ITALY. 

On  August  17,  1910,  cholera  was  reported  in  Italy.  The  cause  of  the  out- 
break is  alleged  to  have  been  the  embarkation  at  Brindisi  of  a  party  of  Russian 
gypsies  from  Batum.  They  proceeded  by  rail  to  Trani,  which  appeared  to  be 
the  primary  focus  of  the  epidemic.  The  infection  spread  to  various  towns 
and  cities  in  the  Provinces  of  Bari  and  Foggia,  both  in  the  region  of  Apulia. 
In  late  September  the  situation  became  worse  and  cases  of  cholera  were 
confirmed  bacteriologically  and  officially  reported  in  Naples  and  Rome.  By 
October  1st  the  disease  had  been  officially  declared  in  the  Province  of  Salerno 
and  town  of  Auletta,  the  Province  of  Sicily  and  towns  of  Palermo  and  Mon- 
reale.  Mid-October  found  the  Provinces  of  Avellino,  Caserta,  and  Campobano 
also  infected,  and  early  November  added  the  Provinces  of  Girgenti,  Lecce, 
Caltanisetta,  Perugia  and  Trapani  to  the  list.  Cases  continued  to  be  reported 
from  Italy  until  February  4,  1911,  from  which  time  until  June  8,  1911,  when 
there  was  a  cholera  death  at  Reggio  di  Calabria.  Since  that  time  to  September 
2,  1911,  10,397  cases  and  4,123  deaths  have  been  reported  from  no  less  than 
seventeen  different  provinces. 

CHOLERA    IN    AUSTRIA-HUNGARY. 

On  June  20,  1910,  a  case  of  cholera,  apparently  imported  from  Russia,  was 
reported  at  Padwolococzyska  in  Galicia.  August  31st  two  cases  were  reported 
at  Vienna  in  persons  recently  arrived  fiom  Hungary.  September  13th  isolated 
cases  of  cholera  were  reported  in  eight  villages  from  Kressburg  to  Mahacs,  on 
the  Danube.  Later,  cases  were  reported  at  Trieste,  Laibach  and  Gratz,  but  the 
disease  died  down  and  no  cases  were  reported  from  December  17  to  May  24, 
1911,  when  it  reappeared  in  several  localities,  the  bulk  of  the  cases  occurring 
at  Trieste. 

GEOGRAPHICAL    DISTRIBUTION    OF    CHOLERA. 

July   1,   1909,   to   June   30,    1911. 

July  1,  1909,  to  July  30,  1910: 

Asia. — Ceylon,   China,   India,   Indo-China,  Japan,  Java,   Korea,   Manchuria, 

Persia,  Siam,  Siberia,  The  Straits  Settlements. 
Europe. — Belgium,  Germany,  The  Netherlands,  Russia,  Austria-Hungary. 

July  1,  1910,  to  June  30,  1911: 

Asia. — Arabia,  Borneo,  Ceylon,  China,  Federated  Malay  States,  India,  Indo- 
China,  Japan,  Java,  Korea,  Manchuria,  Persia,  Siam,  Turkey,  Straits 
Settlements. 

Africa. — Tripoli,  Tunis. 

Europe. — Austria-Hungary,  Bulgaria,  Denmark,  France,  Germany,  Italy, 
Roumania,  Russia,  Servia,  Turkey. 

North  America. — Canada,*  United  States.f 

South  America. — Brazil. 

MEASURES  TAKEN  AGAINST  THE  INTRODUCTION  OF  CHOLERA  FROM   RUSSIA  AND  ITALY. 

On  account  of  the  widespread  character  of  the  epidemic,  particularly  because 
of  the  conditions  prevailing  in  Russia  and  Italy,  the  enormous  emigration  from 
these  countries  presented  a  quarantine  problem  which  occupied  the  immediate 
and  serious  consideration  of  the  Public  Health  and  Marine  Hospital  Service 
of  the  United  States.  The  measures  instituted  to  prevent  the  introduction  of 
the  disease  may  be  divided  as  follows : 

1.  Quarantine  measures  enforced  at  foreign  ports  of  embarkation. 

2.  Those  enforced  during  the  voyage. 


*At   quarantine. 

fAll  cases   (except  one  at  Auburn,  N.  Y.)    were  at  quarantine. 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  133 

3.  Those  taken  at  the  various  quarantine  stations  in  the  United  States. 

4.  Special  inspections  for  the  detection  of  cholera  made  by  Service  officers 
engaged  in  the  medical  inspection  of  arriving  aliens. 

5.  The  immigration  destination  notification  system. 

QUARANTINE     MEASURES     ENFORCED     AT     FOREIGN     PORTS     OF     EMBARKATION. 

The  measures  enforced  at  the  foreign  ports  of  embarkation,  so  far  as  the 
present  cholera  situation  in  Europe  is  concerned,  date  from  July  14,  1910,  when 
a  request  was  made  through  the  Treasury  Department  for  the  resumption  at 
certain  European  ports  of  the  detention  for  five  days  of  steerage  passengers 
from  the  cholera-infected  districts  in  Russia  prior  to  their  embarkation  to 
the    United    States. 

The  enforcement  of  the  provisions  of  paragraphs  30,  31  and  32  of  the  Quar- 
antine Regulations  of  1903  (paragraphs  29,  30,  and  31,  revised  regulations  of 
1910)  by  the  consular  officers  at  Hamburg,  Bremen,  Antwerp,  Rotterdam,  and 
at  continental  and  British  ports  dates  from  September  17,  1908,  when  the 
prevalence  of  cholera  in  Russia  made  it  necessary  to  provide  for  the  deten- 
tion of  steerage  passengers  for  five  days  in  suitable  barracks  and  for  the 
disinfection  of  their  baggage  at  the  ports  of  departure. 

The  regulations  also  provide  that  cabin  passengers  coming  from  cholera- 
infected  districts  embarking  at  clean  or  infected  ports  should  produce  satis- 
factory evidence  as  to  their  exact  place  of  abode  during  the  five  days  imme- 
diately preceding  embarkation. 

On  January  8,  1910,  these  restrictions  had  been  temporarily  removed  on 
account  of  the  great  diminution  or  almost  complete  absence  of  cholera  in 
Russia,  but,  as  stated  above,  they  were  resumed  on  July  14,  1910.  On  account 
of  the  steadily  increasing  spread  of  the  disease  a  request,  August  9th,  that 
the  consular  officers  at  the  ports  above  mentioned  detain  for  five  days  prior 
to  their  embarkation  steerage  passengers  from  all  parts  of  Russia,  it  being 
considered  impracticable,  not  to  say  impossible,  for  all  the  consular  officers 
to  determine  whether  a  given  group  of  emigrants  were  from  a  district  in 
Russia  not  infected  with  cholera. 

Finally,  on  account  of  the  general  prevalence  of  the  disease  throughout  the 
Russian  Empire  and  the  report  of  its  appearance  in  Germany  and  in  Italy  a 
request  was  made  through  departmental  channels  on  September  2,  1910,  that 
the  consular  officers  at  the  ports  of  Marseilles,  Havre,  and  Cherbourg,  in 
France,  and  the  Italian  ports  of  Genoa,  Palermo,  and  Messina  be  instructed 
to  detain  steerage  passengers  from  all  parts  of  Russia  and  disinfect  their  bag- 
gage prior  to  embarkation  for  the  United  States. 

Medical  officers  of  the  Service  are  regularly  assigned  to  duty  in  the  American 
consulates  at  Naples,  Palermo,  Genoa,  Messina,  and  Catania,  Italy,  Marseilles, 
France,  and  Libau,  Russia.  In  addition  officers  were  detailed  to  inspect  ports 
of  embarkation  in  Italy,  France,  England,  Holland,  Belgium,  Austria-Hungary, 
and  Russia,  in  order  to  include  them  in  a  huge  and  effective  cordon  sanitaire. 
This  outgoing  quarantine  work  performed  at  the  various  foreign  ports  is 
provided  for  by  the  "special  regulations  on  account  of  cholera,  foreign  and 
insular,  paragraphs  24,  25,  26,  29,  30,  31,  and  32. 

Special  attention  is  paid  to  the  inspection  of  intending  emigrants  to  deter- 
mine the  presence  in  their  baggage  or  upon  their  persons  of  foodstuffs,  bottled 
water,  etc.,  which  might  have  been  exposed  to  the  infection,  and  to  the  destruc- 
tion of  such  articles  when  found.  This  inspection  is  made  before  and  after 
the   period    of   detention. 

While  the  methods  of  procedure  may  differ  to  a  certain  degree  at  the 
various  foreign  ports,  a  description  of  the  routine  at  such  ports  as  Libau  and 
Naples  may  be  taken  as  a  fair  example  of  the  work  under  consideration. 

Emigrants  are  received  until  the  evening  of  the  sixth  day  preceding  the 
sailing  of  the  vessel.  They  are  there  held  for  five  full  days  prior  to  their 
departure  and  subjected  to  a  daily  medical  inspection.  A  personal  inspection 
of  the  vessel  is  made  on  the  day  of  sailing.  Each  family  or  single  person  is 
given  a  dated  green  card,  termed  a  "quarantine"  card,  which  states  the  name 
and  age  of  each  individual,  and  the  fact  that  said  person  is  at  the  time  free 
from  quarantinable  disease.  The  card  is  stamped  by  the  representative  of  the 
Service  at  the  time  of  the  first  examination.     Then  upon  the  day  of  sailing, 


134  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

five  days  later,  the  "quarantine"  cards  are  again  produced,  attached  to  the 
ship's  ticket  as  a  control,  and  after  the  examination  of  the  passenger  the 
card  is  stamped  with  a  date  stamp  marked  "Second  inspection."  All  emigrants 
not  having  a  quarantine  card,  those  with  the  card  not  stamped  and  dated,  or 
those  ill  or  suspected  of  being  ill,  are  recommended  for  detention  in  the  city 
until  the  sailing  of  the  next  vessel,  two  weeks  later. 

MEASURES    ENFORCED    DURING   THE   VOYAGE. 

Not  only  were  the  majority  of  the  steamship  lines  furnished  with  copies 
of  paragraphs  46  to  52,  inclusive,  of  the  United  States  Quarantine  Regulations, 
but,  in  accordance  with  the  general  instructions  therein  contained,  a  general 
order  was  issued  to  practically  all  of  the  trans-Atlantic  lines  running  into 
the  ports  of  New  York,  Boston,  Philadelphia,  Baltimore,  Montreal,  Halifax, 
and  Norfolk  to  instruct  the  ships'  surgeons  to  carefully  inspect  all  passengers 
and  crews,  and  to  particularly  note  their  condition  during  the  24  hours  prior 
to  their  arrival  at  the  ports  above  mentioned. 

MEASURES   TAKEN   AT   THE   QUARANTINE   STATIONS   IN   THE   UNITED    STATES. 

Upon  the  arrival  of  vessels  from  cholera-infected  ports  or  from  ports  from 
which  persons  from  infected  districts  embark,  the  vessel,  together  with  the 
personnel  and  passengers,  are  subjected  to  a  careful  inspection.  This  in- 
cludes a  personal  inspection  of  the  individual,  an  examination  of  any  person 
ill,  and  a  bacteriological  examination  of  the  stools  of  any  reported  to  have 
suffered  from  any  gastro-intestinal  disturbance  en  voyage,  or  whose  appear- 
ance would  so  indicate,  or  who  may  have  been  in  close  contact  with  a  person 
or  persons  whose  illness  is  considered  suspicious. 

The  vessel  is  held  in  quarantine  pending  any  examination  thought  warranted 
by  the  circumstances.  At  this  inspection  the  work  performed  at  foreign  ports 
is  checked  up  and  failures  to  comply  with  the  prescribed  restrictions  are 
discouraged  by  appropriate  measures.  In  cases  of  emergency  an  expert  from 
the  Hygienic  Laboratory  is  detailed  to  conduct  the  investigation  at  the  port 
or  place  where  the  suspected  case  is  being  held. 

SPECIAL    INSPECTIONS    FOR    THE    DETECTION    OF     MILD    OR    PREVIOUSLY     UNRECOGNIZED 
CASES    OF    CHOLERA    MADE    BY    SERVICE    OFFICERS. 

The  medical  officers  of  the  Service  engaged  in  the  inspection  of  arriving 
aliens  have  rendered  invaluable  aid  by  carefully  endeavoring  to  detect  cases  of 
cholera  which  on  account  of  obscure  symptoms  might  have  passed  the  regular 
quarantine  inspection.  The  result  has  been  that  the  medical  inspection  of 
arriving  aliens  may  be  rightly  classed  as  an  important  line  of  quarantine 
defense. 

When  a  death  from  cholera  occurred  July  20,  1911,  at  the  Boston  quarantine 
station  and  three  days  later  a  death  occurred  at  the  New  York  quarantine 
station  from  the  same  disease,  specially  qualified  officers  of  the  Service  were 
stationed  at  those  ports  to  reinforce  the  quarantine  inspection  by  special  phys- 
ical and  bacteriological  examinations.  These  prompt  measures  have  thus  far 
resulted  in  the  apprehension  of  the  imported  cases  before  their  departure 
inland. 

THE     IMMIGRANT     DESTINATION     CERTIFICATION. 

It  was  thought  that  the  measures  above  described  were  ample  in  scope  and 
effectiveness  to  meet  the  cholera  conditions,  and  the  quarantine  problem  caused 
thereby,  save  in  one  particular,  and  that  was  in  the  case  of  "cholera  carriers." 
The  fear  of  the  "cholera  carrier"  from  a  quarantine  standpoint  arises  from 
the  uncertainty  as  to  the  duration  of  the  infectivity  of  the  individual.  While 
the  majority  of  observers  assert  that  "carriers"  lose  their  vibrios  in  10  days, 
certain  authorities  claim  that  the  vibrios  are  carried  for  much  longer  periods, 
even  as  long  as  69  days.  The  average  time  elapsing  between  the  beginning 
of  the  period  of  detention  of  emigrants  at  a  foreign  port  and  the  landing  at 
the  United  States  port  is  about  17  days.  This  is  7  days  in  excess  over  the 
commonly  accepted  period  during  which  vibrios  are  carried  and  is  a  source 
of  much  safety  and  confidence.  But  the  "cholera  carriers"  of  long  duration, 
however   infrequently   they    may   be    encountered,    presented    a    problem    which 


FIFTH   INTERNATIONAL  SANITARY   CONFERENCE. 


135 


could  only  be  met  by  the  establishment  of  a  system  by  which  the  services  of 
the  local  health  officers  throughout  the  United  States  could  be  utilized  in 
keeping  under  surveillance  those  localities  wherein  newly  arrived  immigrants 
are  domiciled.  An  arrangement  was  therefore  effected  at  all  the  large  immi- 
gration stations  by  which  the  destination  of  each  immigrant  from  a  cholera- 
infected  country  is  recorded  on  a  separate  card.  The  cards  are  then  segre- 
gated according  to  the  States  to  which  the  immigrant  is  destined  and  mailed 
daily  to  the  secretaries  of  the  various  State  boards  of  health  for  further 
distribution  to  the  local  health  officers  in  each  State.  The  facsimile  of  the 
face  and  back  of  the  card  below  will  show  the  form  in  which  the  information 
is  sent. 

(Face) 
IMMIGRANT   DESTINATION    CARD 


Port  of.. 


MONTH 


Jan. 

Feb. 

Mar.          Apr. 

May 

June 

July 

Aue. 

Sep.      1     Oct. 

Nov. 

Dec. 

DAY 


2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

Name  of  Immigrant 

From  what  Country? ITALY RUSSIA 

(Check  indicates  the  country) 

DESTINATION 


Ala. 

!   Cal. 

Del. 

Ga. 

Ind. 

Ky. 

Md. 

Minn. 

Neb. 

N.J. 

N.C.     Ok!a. 

:  r.i. 

Tenn.l     Vt. 

W.Va. 

STATE: 

Ariz. 

Colo. 

D.  C. 

Idaho 

Iowa 

La. 

Mass. 

Mo. 

Nev. 

N.M. 

N.Dak 

Oreg. 

s.c. 

Tex.  |     Va. 

Wii. 

Ark. 

Conn. 

Fla. 

111. 

Kans. 

Me. 

Mich. 

Mont. 

N.H. 

N.Y. 

Ohio 

Pa. 

S.  Dak 

Litah    Wash. 

Wy. 

Town  or  City Street  and  Number. 


Initials  of  Inspector. 


(Back.) 


TREASURY    DEPARTMENT,    WASHINGTON,    D.    C. 

On  information  received  from  the  Commissioner  of  Immigration,  this  card 
is  sent  to  the  State  boards  of  health  that  they  may  be  informed  of  immigrants 
coming  into  the  States  from  countries  in  which  at  the  present  time  cholera 
is  prevalent,  whether  generally  prevalent  or  only  in  certain  districts.  The 
person  named  on  the  reverse  has  been  subject  to  the  quarantine  regulations  at 
foreign  ports,  the  quarantine  inspection  at  the  domestic  port,  and  also  the 
subsequent  immigration  examination.  Notwithstanding  these  precautions,  it  is 
advisable  to  exercise  surveillance  over  arrived  immigrants  from  the  cholera- 
infected  countries  as  named  on  the  reverse,  and  to  this  end  it  is  suggested 
that  this  card  be  sent  to  the  local  health  officer  at  the  point  of  destination, 
so  that  he  may  examine  into  any  case  of  sudden  or  fatal  gastro-enteritis  or 
diarrhea  among  immigrants  to  determine  its  actual  nature,  and  if  any  doubt 
exists,  to  report  to  the  State  Board  of  Health  or  to  the  Public  Health  and 
Marine-Hospital  Service  at  Washington.  This  card  should  not  be  confounded 
with  the  information  required  by  paragraph  67,  U.  S.  Quarantine  Regulations 


136  FIFTH   INTERNATIONAL  SANITARY   CONFERENCE. 

promulgated  October  20,  1910,  relating  to  immigrants  who  have  arrived  on  a 
vessel  on  which  infection  has  appeared  and  whose  destination  after  quarantine 
detention  and  disinfection  would  be  sent  by  telegraph  or  mail. 

Surgeon-General, 
U.  S.  Public  Health  and  Marine-Hospital  Service. 

CHOLERA     SITUATION     DURING    THE     SUMMER     OF     1911. 

With  onset  of  summer,  cholera  began  to  be  reported  in  various  places  in 
Europe  and  it  was  feared  that  cases  would  be  exported  to  the  United  States 
in  spite  of  all  precautions  at  foreign  ports  of  embarkation.  These  fears 
were  realized  when  on  June  13,  1911,  the  quarantine  officer  of  the  port  of 
New  York  reported  that  a  steerage  passenger  from  southern  Italy  who  had 
embarked  June  2d  at  Naples  had  died  June  6th  of  cholera  while  en  voyage. 
Fortunately  some  of  his  discharges  had  been  saved  by  the  ship's  surgeon. 
When  these  were  examined  at  the  Hygienic  Laboratory  in  Washington  the 
clinical  diagnosis  of  cholera  was  confirmed.  On  June  14th  a  second  case  was 
reported,  while  on  June  20th  four  cases  were  discovered  at  the  port  of  New 
York  on  an  Italian  steamship  arriving  from  Genoa,  Naples  and  Madeira. 
On  the  same  date  a  "cholera  carrier"  was  discovered  at  the  same  port  on 
board  a  vessel  from  Patras,  Greece,  and  Palermo,  Italy.  The  "carrier"  had 
embarked  at  Patras. 

A.s  a  result  of  the  foregoing,  all  quarantine  officers  on  the  Atlantic  and  Gulf 
coasts,  and  all  officers  engaged  in  the  examination  of  alien  immigrants  both 
at  home  and  in  Europe  were  warned  that  careful  inspection  was  necessary 
to   detect  atypical  cases  or  bacillus  carriers  and  concealed   food. 

On  June  30,  1911,  the  immigrant  destination  notification  system  proved  its 
value  in  a  signal  manner.  An  Italian  boy  who  arrived  on  the  Italian  steamship 
on  which  four  cases  were  found  June  20th  (vide  supra),  after  being  detained 
for  seven  days  at  quarantine,  went  to  Auburn,  N.  Y.,  where  he  sickened 
June  30th  and  died  the  following  day.  A  second  case  of  cholera  from  the 
same  steamship  occurred  in  an  Italian  woman  who  was  taken  ill  in  Brooklyn, 
June  30th,  and  died  July  4,  1911,  at  quarantine,  where  she  had  been  sent.  It 
is  probable  that  these  two  cases  were  "carriers,"  and  to  diminish  the  danger 
from  such  cases  the  following  additions  to  the  United  States  Quarantine 
Regulations  were  promulgated : 

"All  steerage  passengers  arriving  at  ports  in  the  United  States  from  ports 
or  places  infected  with  cholera  shall  be  subjected  to  bacteriological  examina- 
tion and  shall  not  be  admitted  to  entry  until  it  has  been  determined  by  said 
examination  that  they  are  not  cholera  bacillus  carriers." 

The  above  was  in  addition  to  the  regulations  contained  in  a  circular  issued 
July  6,    1911,  which  provided: 

"Cholera  Bacillus  Carriers. 

"To  diminish  the  danger  from  cholera  bacillus  carriers,  steerage  passengers 
coming  from  ports  or  places  where  cholera  prevails  and  arriving  on  vessels 
upon  which  cholera  has  appeared,  shall  be  detained  ten  days  for  observation 
unless  after  five  days'  detention  they  are  found  not  to  be  bacillus  carriers. 

"The  same  provision  shall  also  apply  to  other  persons  arriving  on  said 
vessels  who  for  special  reasons  are  deemed  liable  to  be  thus  infected." 

On  July  29.  1911,  the  Canadian  Government  issued  orders  that  "all  steerage 
passengers  arriving  at  ports  in  Canada  from  ports  or  places  infected  with 
cholera  shall  be  subjected  to  bacteriological  examination  at  the  quarantine 
station  of  the  port  and  shall  not  be  permitted  to  pass  such  station  or  to  make 
customs  entry  until  it  has  been  determined  by  such  examination  that  they  are 
cholera-bacillus  carriers."  This  measure  acted  as  a  protection  to  the  United 
States  inasmuch  as  not  infrequently  persons  from  infected  ports  take  passage 
for  the  United  States  via  Canada. 

The  protective  value  of  the  above-mentioned  measures  instituted  by  the 
United    States   and    Canadian    Government    was   at   once   apparent.     A    cholera 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  137 

carrier  was  apprehended  at  the  Gross  Isle  Quarantine  and  from  the  time  that 
the  examinations  were  begun  at  the  port  of  New  York,  September  5th,  twenty- 
six  carriers  were  found  among  detained  passengers  and  crews.  No  case  of 
cholera  has  occurred  in  the  United  States  since  July  23d,  and  no  case  of 
cholera  has  arrived  at  a  port  of  the  United  States  since  August  18,  1911. 

CRITERION    OF    IMMUNITY    IN    YELLOW    FEVER. 

By  G.  M.  Guiteras,  A.M.,  M.D., 
Surgeon,  U.  S.  Public  Health  and  Marine  Hospital  Service. 

The  problem  of  immunity  in  relation  to  infective  and  contagious  diseases 
has  a  most  important  bearing  on  all  branches  of  practical  medicine,  but  in  none 
more  so  than  in  preventive  medicine,  which  branch  is  the  special  and,  in  fact, 
the  only  theme  for  discussion  before  this  conference.  And  we  may  well  feel 
that  in  advancing  the  principles  of  preventive  medicine  we  are  doing  an 
altruistic  and  humanitarian  service  of  which  the  medical  profession  may  well 
be  proud. 

Immunity  is  that  condition  of  the  body  cells  which  make  them  resistent  to 
the  invasion  of  a  parasitic  germ  or  to  the  toxin  produced  by  it. 

The  fascinating  study  of  how  immunity  is  produced  has  made  great  strides 
of  late,  due  to  the  labors  of  such  noted  scientists  as  Metchnikoff,  Ehrlich,  and 
others,  but  it  is  not  our  present  purpose  to  deal  with  that  phase  of  the  subject, 
but  to  confine  ourselves  to  its  practical  side  from  the  viewpoint  of  the  sani- 
tarian, and  with  special  reference  to  yellow  fever. 

Immunity  may  be  natural,  that  is,  inborn  in  the  individual,  or  it  may  be 
acquired.  When  acquired,  it  may  be  the  result  of  natural  causes,  such  as  a 
previous  attack  of  the  disease  in  question,  or  it  may  be  brought  about  by 
artificial  means,  such  as  the  injection  into  the  body  of  an  antitoxin,  as  in  the 
immunity  conferred  by  the  use  of  diphtheria  antitoxin  or  antityphoid  serum. 
In  either  case,  a  change  occurs  in  the  cells  of  the  body,  making  them  resistent 
to  the  invasion  of  the  same  pathogenic  organism  or  its  toxins. 

The  immunity  conferred  in  the  latter  case  as  in  the  former  is  not  absolute. 
In  diphtheria  it  lasts  but  a  short  time;  in  the  exanthemeta,  in  typhoid  yellow 
fever,  etc.,  the  immunity  conferred  by  a  previous  attack  of  the  disease  may 
persist  for  a  lifetime. 

But  even  in  the  diseases  just  mentioned  there  are  exceptions,  that  is,  cases 
do  occur  in  which  a  previous  attack  of  the  disease  fails  to  confer  immunity 
on  the  subject  attacked,  although  it  is  well  known  that  these  exceptions  are 
rare.  Many  cases  are  cited,  it  is  true,  where  a  second  or  even  a  third  attack 
of  yellow  fever  has  occurred  in  the  same  individual,  but  human  judgment  is 
so  very  prone  to  err  that  it  is  more  than  probable  that  in  many  of  these  cases 
a  mistake  was  made  in  the  diagnosis  either  in  the  first  febrile  attack  or  in  a 
subsequent  one.  I  think,  that  admitting  the  possibility  of  a  second  attack,  in 
so  far  as  yellow  fever  is  concerned,  it  may  be  considered  sufficiently  rare  as 
to  be  a  negligible  quantity  for  practicable  purposes  such  as  quarantine  restric- 
tions, and  we  are  therefore  within  a  reasonable  limit  of  safety  in  admitting 
that  a  previous  well-authenticated  attack  of  yellow  fever  may  be  accepted  as 
conferring  immunity  for  quarantine  purposes. 

The  next  step,  and  a  most  important  one,  is  to  determine  what  we  are  to 
accept  as  evidence  of  a  "well-authenticated  attack  of  yellow  fever."  This  is  a 
difficult  and  delicate  subject,  because  it  necessitates  a  determination  of  the 
professional  ability  and  the  probity  of  a  brother  physician.  Unfortunately,  we 
have  to  admit  that  some  of  our  confreres  (a  very  small  proportion,  to  be 
sure)  are  at  times  willing  to  take  a  long  chance  in  signing  immune  certificates, 
and  for  friendship's  sake  or  for  pecuniary  gain,  to  certify  to  that  which  is  not 
true.  I  would,  therefore,  insist  that  in  order  to  accept  a  person  as  immune 
as  the  result  of  a  previous  attack  it  should  be  necessary  to  present  a  certificate 
from  the  attending  physician  stating  that  the  person  interested  has  had  an 
attack  of  yellow  fever  and  was  treated  by  him  for  that  disease.  Further,  such 
certificates  should  be  accepted  only  from  men  of  the  highest  integrity  and  of 
recognized  familiarity  with  the  disease  in  question. 

I  am  of  the  opinion  that  only  under  the  above  conditions  should  a  certificate 
of  immunity  be  accepted   for  quarantine  purposes. 


138  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

It  has  heretofore  been  the  general  custom  and,  in  fact,  is  incorporated  in 
our  quarantine  regulations,  that  a  ten  years'  residence  in  an  endemic  focus 
of  yellow  fever  is  sufficient  to  confer  immunity,  and  that  a  certificate  to  that 
effect  might  be  accepted  by  the  sanitary  authorities  on  sufficient  evidence  of 
such  term  of  residence. 

It  always  has  seemed  to  me  that  this  is  an  error,  that  is,  that  it  was 
opening  the  door  too  widely  and  was  a  dangerous  practice.  For  there  are 
localities  even  in  endemic  foci  where  one  might  live  for  years  with  but  slight 
chance  of  becoming  infected,  as  for  instance,  where  one  is  surrounded  by 
immune  individuals. 

This  objection,  however,  is  very  much  enhanced,  since  the  determination 
of  the  method  of  transmission  of  yellow  fever,  for  it  is  quite  clear  that,  at 
the  present  time,  an  intelligent,  well-informed  and  careful  individual  could 
live  for  any  number  of  years  in  an  endemic  focus  of  yellow  fever  and,  while 
susceptible  to  the  disease,  never  contract  it.  It  would  be  only  necessary  to 
protect  oneself  against  the  bite  of  the  mosquito,  and  this  under  ordinary 
circumstances  would  not  be  difficult  of  accomplishment.  Just  as  in  the  case 
of  cholera  Asiatica  one  may  reside  in  an  infected  locality  and  escape  all  danger 
of  infection  from  that  dread  disease  by  merely  boiling  or  heating  to  the 
required  temperature  everything  taken  into  the  alimentary  canal,  so  also,  one 
may  remain  in  a  place  infected  with  yellow  fever  and  taking  easily  applied 
precautions  against  the  bite  of  the  mosquito  escape  all  danger  of  contracting 
the   disease. 

I  would  therefore  recommend  that  our  present  regulations  be  so  amended  as 
to  eliminate  that  proviso  which  accepts  ten  years'  residence  in  an  endemic  focus 
of  yellow  fever  as  evidence  of  immunity  against  that  disease. 

It  is  to  be  hoped  that  in  the  near  future  we  may  be  fortunate  enough  to 
discover  the  causative  agent  of  yellow  fever,  and  that  as  a  result  thereof  we 
may  be  able  to  prepare  a  serum  that  will  confer  either  a  temporary  or  rela- 
tively absolute  immunity  against  the  disease,  such  as  we  now  have  in  typhoid 
or  in  variola.  Under  such  circumstances  travel  from  infected  points  would 
be  greatly  facilitated,  and  the  danger  of  infecting  healthy  localities  reduced 
to  a  minimum. 

PROTECTIVE    MEASURES    AGAINST    CERTAIN    COMMUNICABLE    DISEASES. 

The  diseases  represented  in  this  report  are  mostly  those  the  gravity  of  which 
is  being  more  and  more  fully  appreciated.  The  list  is  by  no  means  complete, 
but  it  is  supposed  that  in  future  conferences  time  will  be  reserved  for  the 
discussion  of  such  diseases  also  as  typhoid  fever,  pellagra,  uncinariasis,  amoebic 
infections,  ophthalmia  meonatorum,  infantile  paralysis,  etc.,  the  importance 
of  which  all  sanitarians  of  all  nations  must  realize,  and  in  regard  to  which 
considerable  is  now  being  done  in  the  United  States. 

Tuberculosis. — The  campaign  against  this  disease  which  received  such  great 
impulse  following  the  meeting  of  the  Eighth  International  Congress  on  Tuber- 
culosis in  the  United  States  in  1908  has  continued  with  unabated  force. 

The  legislation  enacted  in  the  last  two  years  has  been  reviewed  in  Report 
No.  1.  The  Federal  Government,  which  already  maintained  sanatoriums  at 
Fort  Stanton  for  seamen  of  the  merchant  marine,  at  Fort  Bayard  for  soldiers, 
and  at  Las  Animas  for  sailors  of  the  navy,  has  added  five  more  institutions 
of  the  same  character  intended  exclusively  for  the  use  of  persons  of  the 
Indian   race. 

The  combined  efforts  of  the  various  agencies  engaged  all  over  the  country 
in  fighting  tuberculosis  have  been  effective  in  bringing  the  death  rate  down 
from  173.9  per  100,000  of  population  in  1908  to  167.5  in  1909,  and  160.3  in  1910. 
There  is  good  reason  to  believe  that  these  encouraging  results  will  persist. 
The  National  Association  for  the  Study  and  Prevention  of  Tuberculosis,  which 
is  an  unofficial  organization  has  its  headquarters  in  New  York,  and  continues 
a  factor  of  the  first  importance  in  promoting  both  public  and  private  enter- 
prise aiming  at  the  ultimate  control  of  the  disease. 

The  rapid  extent  and  increasing  force  of  the  movement  may  be  judged  from 
the  fact  that,  as  shown  in  the  last  Tuberculosis  Directory  published  by  the 
above-mentioned  association,  there  were  in  1911,  342  dispensaries  and  clinics 
for  the   treatment   of   tuberculosis    in   the   United    States,   an    increase   of   324 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  139 

over  those  existing  in  1905  (18)  ;  the  number  of  sanatoria  showed  a  similar 
augmentation  from  111  in  1905  to  422  in  1911.  The  number  of  associations 
for  the  prevention  of  tuberculosis  rose  from  18  in  1905  to  511  in  1911.  With 
the  exception  of  Alaska,  Idaho,  Mississippi,  Nevada,  South  Dakota,  Utah, 
Vermont,  and  Wyoming,  such  associations  now  exist  in  varying  numbers  in 
every  State,  territory,  and  dependency  of  the  United   States. 

The  realization  by  the  public  of  the  dangers  of  this  disease  has  proved  of 
sufficient  strength  to  secure  not  only  the  enactment  of  laws  for  the  registra- 
tion of  cases,  creation  of  sanatoria,  disinfection,  etc.,  having  as  an  object  the 
direct  control  of  the  disease,  but  also  of  others  relative  to  sanitation  and 
ventilation  of  factories,  regulation  of  housing  conditions,  abolishment  of  the 
public  drinking  cup,  suppression  of  promiscuous  expectoration,  medical  inspec- 
tion of  schools,  etc.,  which  must  necessarily  be  influential  in  bringing  about 
a  general  improvement  of  sanitary  conditions,  and  a  diminution  of  morbidity 
and   mortality  rates. 

Venereal  Diseases. — The  national  immigration  law  excludes  from  admission 
into  the  United  States  persons  afflicted  with  a  loathsome  or  dangerous  con- 
tagious disease.  The  regulations  prepared  by  the  Public  Health  and  Marine 
Hospital  Service  includes  syphilis,  gonorrhea,  and  soft  chancre  in  the  category 
of  loathsome  contagious  diseases,  and  therefore  patients  suffering  from  any 
venereal  disease  can  not  obtain  admission  to  the  United  States. 

Syphilis  and  gonorrhea  are  by  law  declared  reportable  diseases  in  only  two 
of  the  States  that  form  the  Union,  namely,  California  and  Utah.  Both  of 
these  laws  were  enacted  during  the  present  year. 

The  employment  in  food-handling  establishments  of  persons  with  venereal 
diseases  is  forbidden  in  California,  Illinois,  Indiana  (bakeries  and  confec- 
tioneries only),  Kansas  (by  rules  of  the  State  Board  of  Health),  Nebraska, 
New  Hampshire,  Pennsylvania  (only  in  bakeshops),  Rhode  Island  (only  in 
bakeries,  confectioneries,  and  ice-cream  shops),  Tennessee,  Utah  (only  in 
meat-selling  and  handling  establishments,  and  Washington  (same  as  Penn- 
sylvania.) 

Various  provisions  have  been  made,  forbidding  the  exercise  of  the  barber's 
trade  to  persons  with  syphilis,  requiring  sterilization  of  tools  and  knowledge 
on  the  part  of  the  barber  of  the  most  common  manifestations  of  face  and 
skin  diseases,  etc.  To  avoid  the  propagation  of  this  disease  in  barber  shops 
the  above  provisions  are  contained  in  laws  of  Colorado,  Connecticut,  Illinois, 
Kansas,  Louisiana  (in  regulations  of  the  State  Board  of  Health),  Michigan, 
Minnesota,  Missouri,  New  Hampshire,  North  Dakota,  Oregon,  Rhode  Island, 
Texas,  Utah,  Washington,  Wisconsin,  and  District  of  Columbia  (by 
regulation). 

Hospital  facilities  for  this  kind  of  patients  must  be  provided  in  Massa- 
chusetts, while  prisoners  with  syphilis  must  be  isolated  in  the  same  State,  and 
retained   in  prison   until   cured,   in   both   Massachusetts   and   Connecticut. 

A  law  of  the  State  of  New  York  passed  in  1910  requiring  the  detention  of 
diseased  prostitute  prisoners  until  cured  occasioned  numerous  protests  on  the 
part  of  women  who  complained  of  discrimination  against  their  sex,  and  has 
recently  been  declared  unconstitutional   by  the  courts. 

A  law  providing  for  the  sterilization  of  syphilitic  patients  kept  in  public 
institutions  was  enacted  this  year  in  Iowa,  and  there  is  little  doubt  that  the 
asexualization  laws  in  force  in  California,  Connecticut,  and  Indiana  could  be 
made  to  apply  to  such  patients,  although  they  are  not  specifically  mentioned 
in  the  statutes. 

Marriage  of  patients  while  the  disease  is  communicable  is  forbidden  by  the 
laws  of   Indiana  and   Michigan. 

Employment  of  persons  suffering  with  syphilis,  such  as  school  janitors  or 
teachers,  is  forbidden  by  the  laws  of  Indiana,  and  admission  to  school  of 
pupils  with  venereal  diseases  is  prohibited  in  West  Virginia,  the  fact  to  be 
ascertained  by  annual  medical  inspections. 

The  use  of  barbershops  or  public  bathrooms  by  patients  is  prohibited  by 
regulations  of  the  State  Board  of  Health  in  Kansas. 

Dissemination  by  advertisement  or  otherwise  of  information  regarding  vene- 
real diseases  or  remedies  therefore  is  interdicted  in  Massachusetts,  Minnesota, 
and  Ohio. 

With   a   view  to   preventing  the   spread   of   syphilis   and   other   diseases,  the 


140  FIFTH    INTERNATIONAL  SANITARY  CONFERENCE. 

use  of  suction  shuttles  in  factories  is  forbidden  in  Massachusetts,  and  the 
promiscuous  use  of  public  drinking  cups  abolished  by  law  or  regulation  in 
sixteen  of  the  States  and  a  number  of  the  most  important  cities ;  while  the 
use  of   roller  towels  was  stopped   in  Kansas  and  Connecticut. 

Venereal  diseases  are  specifically  exempted  by  law  from  control  as  "com- 
municable diseases"  in  Connecticut  and  Tennessee. 

Power  to  issue  regulations  to  prevent  their  spread  is  vested  in  the  State 
Board  of  Health  of  Utah. 

The  foregoing  is  a  resume  of  the  most  important  legislation  relative  to 
venereal  diseases  enacted  in  the  United  States.  The  control  of  these  diseases 
is  a  subject  that  has  attracted  considerable  attention  in  this  country,  especially 
during  the  last  few  years.  In  the  discussion  of  this  problem  a  great  disparity 
of  views  prevails  here  as  elsewhere,  and  many  of  the  measures  already  adopted 
must   be   considered   as   purely   tentative. 

A  number  of  bills  approved  by  the  medical  profession  requiring  medical 
examination  of  aspirants  to  marriage  have  been  introduced  in  several  legis- 
latures, but  none  have  so  far  been  adopted. 

"Reglementation"  in  the  European  sense  has  been  tried  in  at  least  two  cities, 
but  general  opinion  seems  to  be  against  it. 

A  number  of  societies  have  been  formed  in  several  States  to  combat  through 
educational  means  the  spread  of  venereal  diseases,  and  several  of  them  are 
doing  effective  work.  The  national  organization,  the  American  Society  of 
Sanitary  and  Moral  Prophylaxis,  has  especially,  since  its  foundation,  been 
active,  conducting  a  wise  campaign  of  education,  by  means  of  publications, 
public  addresses,   and  otherwise. 

Quite  thorough  studies  of  the  social  conditions  that  lead  to  the  spread  of 
venereal  diseases  has  been  made  by  several  commissions  in  some  of  the  largest 
cities  of  the  country,  namely,  New  York,  Chicago,  and  Minneapolis,  the  result 
of  the  investigations  conducted  being  embodied  in  voluminous  publications. 

At  the  last  meeting  of  the  American  Public  Health  Association,  held  at 
Milwaukee  in  September,  1910,  the  matter  received  attention  at  the  hands  of 
some  of  the  leading  sanitarians  of  the  country.  The  committee  appointed  the 
year  before  by  the  association  rendered  a  report  containing  the  following 
recommendations : 

I.  The  recognition,  study  and  control  of  the  prevalence  of  gonorrhea  and 
syphilis  by  the  State  boards  of  health,  as  with  all  other  communicable  pre- 
ventable diseases,  by  securing  reports  from  physicians  of  cases  by  number,  at 
first  by  request  and  later  by  legal  requirements,  in  order  to  ascertain  the 
distribution  of  these  diseases. 

II.  An  educational  campaign  for  parents  of  all  social  classes  and  children 
of  all  ages  and  sexes.  This  teaching  should  be  not  only  moral  but  also 
medical  in  the  widest  sense.  It  will  not  do  at  present  to  rely  on  the  moral 
argument. 

(a)  Proper  distribution  of  circulars,  pamphlets  and  other  literature  by 
State  Health  Departments  through  all  suitable  channels. 

(b)  State  Health  Departments  to  instruct  all  its  local  health  officers  in- 
sexual  matters  and  direct  them  to  make  a  systematic  effect  to  educate  the 
people  in  their  respective  communities. 

(c)  State  Health  Departments  to  make  a  definite  and  determined  effort 
to  awaken  and  interest  the  medical  profession  in  this  fight  against  venereal 
diseases. 

(d)  State  Health  Departments  to  send  out  especially  trained  paid  teachers 
and  lecturers  of  their  own,  supported  by  exhibits  and  lantern  slides,  to  address 
special  meetings  of  parents,  health  officers,  medical  men,  teachers  and  others 
in  schools,  colleges,  churches,  etc.,  on  these  and  other  preventable  diseases. 

(e)  State  Health  Departments  to  encourage  the  organization  of  local 
leagues  or  associations,  whose  purpose  shall  be  the  support  of  and  control  of 
a  crusade  against  the  spread  of  all  communicable  diseases. 

1.  Said  societies  to  include  every  profession  and  walk  of  life. 

2.  To  depend  preferably  upon  philanthropists  for  necessary  funds,  rather 
than  upon  paid  subscriptions   for  financial  support. 

(f)  State  Health  Departments  to  interest  and  provide  for  the  authorities. 
having  charge  of  the  educational  curriculum  in  public  and  private  schools. 

1.     By  introduction  of  biology  into  the  graded  course  of  all  schools. 


FIFTH   INTERNATIONAL  SANITARY  COXFEREXCE.  141 

2.  By  introduction  into  the  text  books  on  physiology  of  the  upper  grades 
instruction  in  reference  to  anatomy  and  physiology  of  the  urinary  and  sexual 
organs. 

3.  By  special  instruction  to  normal  school  students  who  are  to  become  the 
instructors.  To  impress  upon  the  preceptors  and  teachers  of  these  subjects, 
presidents  and  deans  of  all  colleges,  the  necessity  of  repeated  instruction  in 
reference  to  the  communicability  of  syphilis  and  gonorrhea,  and  to  inculcate  a 
morale  of  protection  among  the  college   fraternities. 

4.  To  utilize  the  public  press  for  the  proper  occasional  presentation  of  the 
.subject  and  to  discourage  the  display  of  advertising  matter  which  encourages 

the  exposure  to  danger  in  these  diseases. 

5.  To  utilize  churchmen's  clubs,  fraternal  societies,  trades  unions,  women's 
clubs,  and  especially  mother's  clubs  for  the  immediate  instruction  of  parents. 

(g)     State  Health  Departments  to  recommend  the  enactment  of  laws  for: 

1.  Registration,   physical   inspection   and   segregation  of   prostitutes. 

2.  Notification  and  report  (by  number  if  desired)  of  venereal  cases. 

3.  Physical  examination  of  men  before  marriage. 

4.  Penalizing  and  holding  to  a  strict  (perhaps  money  damage)  accounta- 
bility those  knowingly  responsible  for  the  transmission  of  venereal  diseases. 

5.  Keeping  open  free  night  dispensaries  and  maintenance  of  special  dispen- 
saries and  hospitals  for  these  diseases. 

III.  Advocacy  of  temperance  on  account  of  the  relationship  between  alco- 
holism, venereal  diseases  and  insanity. 

IV.  Advocacy  of  personal  cleanliness  and  venereal  prophylaxis  for  those 
whose  carnal  appetites  can  not  be  controlled  by  the  agencies  of  moral 
prophylaxis. 

V.  Advocacy  of  early  marriages. 

Smallpox. — The  ravages  of  this  disease  having  from  time  immemorial  been 
so  marked  and  severe,  the  knowledge  of  its  seriousness  being  so  general,  it  is 
only  natural  that  the  volume  of  legislation  relative  thereto  should  greatly 
exceed  that  enacted  for  the  control  of  any  other  disease.  Smallpox  is  in  every 
part  of  the  Union  classed  as  a  "dangerous  communicable  disease''  subject  to 
control  by  the  health  authorities.  It  is  named  as  one  of  the  six  quarantinable 
diseases  in  the  United  States  quarantine  regulations,  persons  arriving  at  ports 
of  the  United  States  who  have  been  exposed  to  the  disease  being  required  to 
be  vaccinated  or  quarantined  not  less  than  14  days  since  last  exposure. 

General  vaccination  is,  under  certain  restrictions,  made  compulsory  in  only 
10  States,  2  territories,  and  the  District  of  Columbia ;  in  two  others  it  may 
be  made  such  whenever  deemed  necessary  by  the  State  Board  of  Health.  In 
seventeen  more  it  may  be  enforced  by  local  authorities.  The  vaccination  of 
exposed  persons  is  required  by  the  State  Board  of  Health  in  four  other 
States,  and  recommended  in  two  more.  The  attendance  at  school  of  unvac- 
cinated  persons  is  forbidden  by  law  in  fifteen  States;  and  in  Porto  Rico  the 
adoption  of  this  measure  is  optional  with  local  school  authorities,  and  in  7 
other  States,  and  can  only  be  enforced  during  periods  of  epidemic  in  7  others. 
Compulsory  vaccination  is  forbidden  in  the  laws  of  4  States,  and  in  one  it  is 
declared  unlawful  to  make  vaccination  a  condition  to  admission  to  school. 
No  reference  is  made  to  vaccination  in  the  laws  or  health  regulations  of 
5   States  and  Alaska. 

The  reports  received  by  the  Surgeon-General  of  the  Public  Health  and 
Marine  Hospital  Service  indicate  that  there  has  been  marked  decrease  in  the 
prevalence  of  the  disease  for  the  last  ten  years.  There  were  55,857  cases 
reported  for  the  year  1902,  42,950  for  the  year  1903,  25,106  for  the  year  1904. 
Only  10,554  cases  were  reported  for  the  year  1906,  and  14,377  for  the  year 
1907.  During  the  fiscal  years  1908,  31,200  cases;  1909,  24,657  cases;  1910, 
25,084;  1911,  35,204  cases  were  reported  respectively.  The  increase  in  the 
number  of  cases  for  the  last  four  years  furnishes  perhaps  evidence  of  a 
better  and  more  thorough  system  of  reporting  cases  rather  than  of  an  actual 
increase  in  the  occurrence  of  smallpox. 

The  unusually  mild  character  of  the  type  of  the  disease  prevailing  in  the 
United  States  is  revealed  in  its  extremely  low  mortality.  The  census  reports 
show  a  steady  diminution  in  the  death  rate  per  100,000  inhabitants,  which  as 
3.4  for  the  quinquennium  1901-1905;  0.5  for  the  year  1905;  0.2  for  the  years 
1906,  1907,   1908,  and  1909;  and  0.4  for  the  year  1910.     The  actual  number  of 


142  FIFTH    INTERNATIONAL  SANITARY  CONFERENCE. 

deaths  was  a  yearly  average  of  1,119  from  1901-1905;  308  for  1905;  95  for 
1906;  74  in  1907;  92  in  1908;  79  in  1909;  202  in  1910.  The  comparative  high 
mortality  for  the  year  1910  must  be  attributed  to  several  sporadic  outbreaks 
of  local  importance  only,  which,  however,  succeeded  in  bringing  up  the  death 
rate   for  the  entire  country. 

The  reports  compiled  by  the  Bureau  of  Public  Health  for  the  calendar  year 
1910  shows  30,352  cases  of  smallpox.  The  benignity  of  the  disease  can  be 
appreciated  from  the  fact  that  there  were  only  415  deaths,  that  is,  a  death 
rate  of  1.63  per  cent,  while  the  mortality  abroad  is  usually  from  20  to  40 
per  cent.  The  State  of  Utah  had  the  highest  case  rate,  with  966  cases,  that  is, 
257.32  for  each  100,000  inhabitants.  The  next  highest  rates  occurred  in  the 
order  indicated  in  North  Carolina,  Florida,  Montana,  Oklahoma,  and  Colorado. 
The  lowest  case  rates  per  100,000  occurred  in  Connecticut  (no  cases)  ;  Mary- 
land (0.46);  New  Jersey  (0.86);  Maine  (1.07);  Pennsylvania  (2.18),  and 
New  Hampshire  (2.32).  It  is  a  noteworthy  fact  that  the  State  of  Utah,  which 
had  also  the  highest  case  rate  in  1909,  namely,  507  cases  for  each  100,000, 
has  a  provision  in  its  statutes  forbidding  compulsory  vaccination  or  to  make 
vaccination  a  condition  to  admission  to  school.  In  none  of  the  other  five 
States  in  which  smallpox  was  highly  prevalent  is  compulsory  vaccination  thor- 
oughly enforced  while  a  systematic  system  of  vaccination  is  practiced  in  the 
six  States  with  the  lowest  case  rate. 

A  striking  departure  in  the  treatment  of  cases  of  smallpox  was  recently 
made  in  Minnesota.  Consistent  with  the  scientific  theory  that  considers  vac- 
cination the  best  protection  against  smallpox,  the  State  Board  of  Health  in 
its  rules  does  not  require  quarantine  in  cases  of  smallpox.  A  sign  is,  however, 
placed  on  the  house  to  serve  as  a  warning  to  the  public,  and  the  patient 
himself  is  not  suffered  to  leave  the  house.  This  policy  has  also  been  adopted 
this  year  by  the  State  Board  of  Health  of  North  Carolina  with  the  avowed 
intention  of  causing  the  people  to  adopt  vaccination  as  the  only  defense 
against    smallpox. 

Malaria. — A  plan  of  campaign  against  malaria  must  of  necessity  depend  on 
the   thorough   enforcement   of   three   measures: 

1.  Compilation  of  statistics  showing  the  prevalence  and  distribution  of 
the  disease. 

2.  Extermination  of  the  agent  that  transmits  the  infection,  the  anopheles 
mosquito. 

3.  Destruction  of  the  malaria  germ  after  it  has  gained  admission  to  the 
human   organism. 

1.  There  are  only  three  States,  California,  Pennsylvania,  and  Vermont, 
which  require  reports  of  cases ;  in  four  others,  Arizona,  North  Dakota,  Okla- 
homa, and  South  Dakota,  the  State  health  authorities  are  empowered  or 
required  to  take  measures  to  prevent  the  spread  of  malarial  diseases.  There 
are  therefore  no  accurate  data  showing  the  prevalence  of  malaria  in  the 
United  States.  The  death  rate  per  100,000  inhabitants  reported  for  the  regis- 
tration area  was  3.9  in  1905,  3.5  in  1906,  2.8  in  1907,  2.5  in  1908,  2.4  in  1909, 
and  2.2  in  1910,  but  as  this  disease  seldom  results  directly  in  death  and  is 
often  reported  under  various  names,  the  above  information  can  hardly  be 
taken  as  a  true  index  of  the  occurrence  of  the  disease. 

2.  The  problem  of  mosquito  extermination  has  usually  been  considered  in 
the  United  States  as  one  for  solution  by  the  individual  community  suffering 
from  this  plague.  Local  action  has  been  taken  in  several  cities,  such  as  New 
Orleans,  for  the  destruction  of  mosquitoes ;  a  section  of  Sanitary  Code  of  the 
City  of  New  York  requires  the  screening  of  water  tanks  to  prevent  the  access 
of  mosquitoes ;  in  most  localities  the  health  authorities  assume  that  "each 
person  is  responsible  for  his  own  mosquitoes,"  and  their  interference  is  limited 
to  the  circulation  of  educational  literature,  the  results  depending  mainly  on 
the  public  spirit  of  the  citizens.  Of  all  the  States,  New  Jersey  has  in  force 
the  most  thorough  system  of  mosquito  eradication,  the  laws  providing  for 
surveys  of  swamp  areas  for  the  purpose  of  determining  the  places  most 
prolific  of  mosquitoes  and  the  times  when  they  are  most  likely  to  appear, 
and  also  for  State  appropriations  to  aid  those  localities  which  are  willing  to 
contribute  to  the  anti-mosquito  work.  Enforcement  of  a  number  of  measures 
to    prevent    the    breeding    of    mosquitoes    in    cisterns,    tanks,    barrels,    buckets, 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  143 

ponds,  etc.,  is  required  in  the  health  regulations  of  Louisiana  and  Hawaii ; 
while  screening  of  cisterns  is  required  in  the  laws  of  Mississippi  and  Texas. 

3.  Contrary  to  the  practice  of  several  foreign  countries,  such  as  Italy, 
Greece,  Bulgaria,  Algeria,  etc.,  free  distribution  of  quinine  at  public  expense 
is   not  practiced   anywhere  in  the  United   States. 

Trachoma. — A  report  on  trachoma  was  presented  by  Surgeon-General  Wyman 
to  the  Third  International  Sanitary  Conference  in  Mexico  in  1907  (see  page 
217  of  the  Transactions).  No  new  developments  relative  to  this  disease  have 
occurred  in  the  United  States,  although  a  part  of  the  medical  press  has  recently 
challenged  the  proof  of  the  contagiousness  of  the  disease.  That  it  is  con- 
tagious there  is  no  doubt.  Abundant  evidence  to  that  effect  can  be  adduced, 
and  the  experience  of  the  Public  Health  Service  in  its  examination  of  over 
1,400.000  persons  since  1891  confirms  this  view.  Furthermore,  there  is  no 
question  regarding  the  wisdom  of  excluding  trachomatous  aliens  from  a 
country. 

Leprosy. — A  report  on  leprosy  was  presented  by  the  United  States  delega- 
tion to  the  Fourth  International  Sanitary  Conference  at  San  Jose,  Costa  Rica, 
in  1907  (see  page  194  of  the  Transactions).  No  further  report  appears 
necessary  at  this  time. 

MORBIDITY    AND     MORTALITY    IN    THE    UNITED     STATES. 

One  of  the  main  purposes  of  this  conference  is  the  prevention  of  the  spread 
of  disease  from  one  country  to  another.  This  is  accomplished  in  part  by  the 
mutual  institution  of  general  sanitary  measures.  However,  the  first  requisite 
in  the  prevention  of  the  spread  of  any  disease,  be  it  from  one  district  or 
province  to  another  district  or  province,  or  from  one  country  to  another,  is  a 
knowledge  of  its  prevalence  and  geographic  distribution  in  the  districts,  prov- 
inces or  countries.  This  knowledge  can  be  acquired  and  made  available  to 
those  concerned  only  by  the  reporting  of  cases  of  sickness.  The  publication 
of  the  exact  status  of  disease  in  the  several  countries  would  assist  in  the 
maintenance  of  a  minimum  maritime  quarantine  and,  by  making  the  prevalence 
of  diseases  in  the  several  countries  comparable,  would  be  a  powerful  incentive 
to  sanitary  progress.  It  would  give  the  sanitary  authorities  exact  information 
by  which  they  could  deal  with  actual  specific  conditions,  instead  of  generali- 
ties, and  would  render  their  work  more  effective  for  the  same  expenditure 
of  time  and  effort. 

Morbidity. — Increased  attention  and  consideration  are  being  given  by  the 
health  authorities  of  the  United  Sttaes,  national.  State,  and  local,  to  the 
reporting  of  cases  of  sickness.  Its  importance,  as  a  basis  of  public  health 
work,  is  receiving  merited  recognition,  as  is  evidenced  by  the  many  laws 
being  enacted  by  the  State  and  city  authorities. 

Each  State  has  jurisdiction  in  regard  to  the  diseases  which  shall  be  reported 
within  its  territory,  and  determines  which  shall  be  notifiable.  The  notifiable 
diseases,  therefore,  vary  to  some  extent  in  the  several  States.  A  list  of  those 
diseases  and  the  number  of  States  requiring  a  report  of  cases  follows: 


144  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

Number  of  States 
Diseases.  requiring  notification. 

Actinomycosis     2 

Anthrax    7 

Beriberi     3 

Cancer    1 

Cerebro-spinal    meningitis    22 

Chagres    fever    1 

Chicken  pox    13 

Cholera    (Asiatic)     35 

Dengue    4 

Diphtheria    37 

Dysentery     1 

Epidemic  dysentery    2 

Erysipelas    3 

Favus     1 

German   measles    3 

Glanders   8 

Gonococcuc    infection    1 

Leprosy    20 

Malarial   fever    2 

Measles     22 

Mumps    3 

Opthalmia  neonatorum    16 

Pellagra    » 4 

Plague 20 

Pneumonia     6 

Poliomyelitis    16 

Puerperal  fever  2 

Rabies    5 

Relapsing  fever   1 

Rocky  Mountain    (spotted)    fever 1 

Scarlet    fever    37 

Smallpox    42 

Syphilis     1 

Tetanus     4 

Trachoma    6 

Trichiniasis    3 

Tuberculosis : 

All   forms    18 

Communicable    1 

Abdominal    1 

Laryngeal     4 

Pulmonary     9 

Typhoid   fever    23 

Typhus   fever    23 

Uncinariasis    4 

Whooping    cough    17 

Yellow    fever    27 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  145 

With  the  present  active  interest  in  public  health  matters,  it  is  believed  that 
practically  all  the  preventable  diseases  will  be  required  before  many  years 
to  be  reported  in  every  State.  This  will  not  only  afford  information  for  the 
immediate  action  of  the  local  health  authorities  concerned,  but  will  give  a 
knowledge  of  the  geographic  distribution  and  prevalence  of  the  diseases 
throughout  the  country,  which  will  be  of  the  greatest  value  in  the  study  of  the 
epidemiology  and  the  factors  operating  in  the  spread  of  these  diseases. 

Cholera. — From  June  14  to  August  18,  1911,  six  cases  of  cholera  arrived  at 
the  New  York  quarantine  on  vessels  from  cholera  infected  localities,  and 
twelve  cases  developed  among  passengers  and  members  of  the  crews  of  these 
vessels  while  under  detention  at  quarantine.  From  June  30th  to  July  19th,  cases 
of  the  disease  developed  among  recently  arrived  immigrants,  or  among  those 
who  had  come  into  intimate  contact  with  them,  at  the  following  places : 

Auburn,    New    York 1  case; 

New   York    City    2  cases ; 

Staten   Island,   New  York 1  case; 

Boston,    Massachusetts    1  case. 

The  patient  in  each  instance  was  isolated,  all  but  the  first  named  being 
removed  to  the  quarantine  station,  and  no  extension  of  the  disease  occurred. 
The  last  case  was  taken  sick  July  19th,  in  New  York  City,  since  which  date 
no  case  has  occurred  in  the  United  States,  outside  of  those  among  the  immi- 
grants detained  at  quarantine. 

Cholera  bacillus  carriers  are  as  important  to  the  sanitarian  as  are  cases  of 
cholera,  and  can  properly  be  classed  with  them.  Measures  enforced  by  the 
Treasury  Department  for  the  detention  of  these  carriers  among  immigrants 
from  cholera  infected  localities  resulted  in  the  finding  of  26  carriers  among 
immigrants  and  members  of  crews  arriving  at  ports  of  the  United  States  on 
vessels  from  cholera  infected  places.  These  were  as  carefully  isolated  as 
the  cases  of  the  disease. 

Smallpox. — Smallpox  in  a  type  so  mild  that  it  is  at  times  recognized  with 
difficulty  has  been  prevalent  throughout  the  greater  part  of  the  country. 
During  the  calendar  year  1909  there  were  reported  24,099  cases  with  only 
150  deaths.  During  the  year  1910  there  were  reported  30,352  cases  with  415 
deaths,  and  from  January  1,  to  June  30,  1911,  17,290  cases  with  56  deaths. 
The  prevalence  of  the  disease  is  undoubtedly  to  a  large  extent  accountable  by 
its  extreme  mildness,  many  of  the  cases  not  being  sufficiently  ill  to  require 
the  services  of  a  physician,  or  even  to  cause  the  patient  to  take  to  bed. 
Because  of  this  many  cases  were  undoubtedly  not  recognized  and  other  indi- 
viduals were  in  consequence  exposed  to  an  extent  that  would  not  have  occurred 
with  a   more  serious  illness. 

During  the  year  1909,  and  more  especially  during  1910,  there  were  a  few 
isolated  outbreaks  of  smallpox  of  a  virulent  type,  and  in  these  the  mortality 
rate  varied  from  16  to  54  per  one  hundred  cases.  The  distribution  of  the 
disease  as  reported  in  the  several  States  is  shown  by  the  following  tables: 


146 


FIFTH   INTERNATIONAL  SANITARY   CONFERENCE. 


SMALLPOX,  1909. 

Showing,    by   States,    Cases   Reported,    Case   Rates,   Deaths   Reported,   and    Case 
Mortality  Rates. 


States. 


1.  Alabama 

2.  Alaska 

3.  Arizona 

4.  Arkansas 

5.  California 

6.  Colorado 

7.  Connecticut 

8.  Delaware 

9.  Dist.    of    Columbia, 

10.  Florida 

11.  Georgia 

12.  Idaho 

13.  Illinois 

14.  Indiana 

15.  Iowa 

16.  Kansas    

17.  Kentucky 

18.  Louisiana 

19.  Maine 

20.  Maryland 

21.  Massachusetts    .    . . 

22.  Michigan 

23.  Minnesota 

24.  Mississippi 

25.  Missouri 

26.  Montana , 

27.  Nebraska 

28.  Nevada  

29.  New    Hampshire    . 

30.  New  Jersey    , 

31.  New   Mexico    

32.  New   York    

33.  North    Carolina     . , 

34.  North   Dakota    

35.  Ohio 

36.  Oklahoma , 

37.  Oregon   .    .    

38.  Pennsylvania   . 

39.  Rhode    Island    

40.  South   Carolina    . . 


41.  South    Dakota 

42.  Tennessee   .    . 

43.  Texas 

44.  Utah 

45.  Vermont  .   .    .  , 

46.  Virginia  .   .    . 


47.  Washington    . 

48.  West  Virginia 

49.  Wisconsin   .    . 

50.  Wyoming  .  .    . 

Total 


Cases. 


Case  rate 
per 

100,000 
inhabit- 
ants.1 


102 

(?) 
(?) 

120 

180 
345 
3 
(?) 

24 

3 

266 

(?) 

2,135 

1,363 

825 
2,197 

390 

1,409 

36 

26 

14 

1,175 

1,430 

76 

221 

685 

109 

(?) 

2 

88 

(?) 

762 

1,733 

204 

1,328 

1,434 

252 

25 

(?) 

19 

13 

680 

752 

1,854 

73 
202 

310 
26 
1,208 
(?) 


24,099 


44.33 
.27 


7.34 
.41 


38.31 

50.74 

37.12 

131.67 


4.87 

2.02 

.42 

42.38 

69.41 


187.46 


.46 
3.56 


8.52 
79.45 
36.72 
28.14 
90.41 
38.65 
.33 


507.11 
20.56 


28.39 
52.14 


Deaths. 


(?) 


(?) 


(?) 


(?) 
(?) 


Case  mor- 
tality rate 
per  hun- 
dred. 


Remarks. 


33.33 


.37 

.37 


4 
(?) 

.18 

3 

1 

4 

14 

(?) 

(?) 
3 

(?) 

(?) 

7.143 
.34 
.98 

.44 

2 
(?) 
4 
2 

2.27 

.52 

.12 

4 
6 

.30 
.42 

9 

2 

2 

14 

5 

.29 
.27 

18 

9 

2.90 

16 
(?) 

1.32 

150 

Incomplete;  no  available  rec- 
ord of  cases  for  entire  State. 

Cases  not  reported. 

1  death  reported;  reports  in- 
complete. 

Incomplete;  no  available  rec- 
ord of  cases  for  entire  State. 
Do. 


No  available  record  of  cases 
for  entire   State. 

Cases  probably  incomplete. 
Incomplete;   181  of  these  cases 

were  reported  in  Macon. 
No  available  record  of  cases. 


Incomplete;  no  available  rec- 
ord of  cases  for  entire  State. 
Do. 


Do. 
Do. 

Do. 
No  available  record  of  cases. 

Do. 


Incomplete;  no  available  rec- 
ord of  cases  for  entire  State. 

Do. 

Do. 
Incomplete. 

Incomplete;  no  available  rec- 
ord of  cases  for  entire  State. 

Do. 

No  reports  received. 


'Based  upon  the  estimated  population  July  1,   1910,  as  given  by  the  Director  of  the  Census. 

Poliomyelitis. — Poliomyelitis  has  been  prevalent  throughout  the  United  States 
for  several  years  to  a  degree  unusual  for  this  disease.  The  authorities,  how- 
ever, have  been  taking  active  measures  to  ascertain  the  cause  of  its  prevalence 
and  the  reasons  for  its  spread.  The  prevalence  and  geographic  distribution 
of  this  disease  as  reported  by  States  for  the  calendar  years  1909  and  1910  are 
shown  by  the  following  tables : 


FIFTH   INTERNATIONAL  SANITARY   CONFERENCE. 


147 


SMALLPOX,  1910. 

Table  No.   1. — Showing,   by  States,  Cases  Reported,  Case  Rates,  Deaths  Reported,  and   Case 

Mortality   Rates. 


Case  rate 

1 

per 

Case  mor- 

Cases. 

100,000 
inhabit- 
ants.1 

Deaths. 

tality  rate 
per  100. 

Remarks. 

616 

'.?) 

No  available  record  of  cases 
for  entire  State.  These 
cases  were  reported  in  Bir- 
mingham, Mobile,  and 
Montgomery. 

(?) 

(?) 

Cases  not  reported. 

(?) 

(?) 

No  available  record  of  cases. 

106 

(?) 

No  available  record  of  cases 
for  State.  These  cases  were 
reported  in  Argenta,  Little 
Rock,  Lonoke,  and  Fort 
Smith. 

California 

177 

1 

Incomplete. 

Colorado    

1,096 

136.23 

7 

0.64 

Connecticut 

None. 

None. 

Delaware 

(?) 

(?) 

No  available  record  of  cases. 

District    of    Columbia.. 

96 

28.89 

Florida 

1,286 

169.50 

12 

.93 

389 

(?) 

No  available  record  of  cases 
for  State.  These  cases  were 
reported  in  the  city  of 
Macon. 

Idaho  

(?) 

(?) 

No  available  record  of  cases. 

Illinois 

730 

12.91 

(?) 

Indiana 

764 

28.24 

1 

.13 

Iowa    

850 

38.19 

1 

.12 

Kansas 

2,202 

129.77 

12 

.54 

Kentucky   

(?) 

No  available  record  of  cases. 

Louisiana 

860 

5 

Reports  are  incomplete. 

Maine 

8 

1.07 

Maryland 

6 

.46 

Massachusetts 

144 

4.26 

Michigan    

2,585 

91.66 

121 

4.68 

Minnesota 

1,002 

48.18 

9 

.90 

Mississippi 

227 

5 

No  available  record  of  cases 
for  State.  These  cases  were 
reported  from  7  cities. 

Missouri 

287 

2 

Do. 

Montana 

634 

167.32 

1 

.16 

Nebraska 

51 

(?) 

No  available  record  of  cases 
for  State.  These  cases  were 
reported  from  Lincoln  and 
South   Omaha. 

(?) 

(?) 

No  available  record  of  cases. 

10 

2.32 

New    Jersey    

22 

.86 

(?) 

(?) 

No  available  recoid  of  cases. 

353 

3.85 

8 

2.26 

North    Carolina    

4,281 

193.45 

8 

.18 

306 

52.51 

2 

.65 

Ohio    

759 

15.88 

10 

1.32 

Oklahoma 

2,342 

139.75 

99 

4.22 

Oregon    

164 

24.18 

5 

3.05 

Pennsylvania 

168 

2.18 

6 

3.57 

No  cases  reported. 

South    Carolina    

(?) 

(?) 

No  available  record  of  cases. 

365 

1 

Report  complete  for  April  to 
December,   inclusive. 

Tennessee 

2,199 

10 

Incomplete. 

Texas    

2,925 

74.72 

67 

2.29 

Utah    

966 

257.32 

2 

.21 

No  cases   reported. 

Virginia 

350 

6 

No  available  record  of  cases 
for  State.  These  cases  were 
reported  from  8  cities. 

Washington 

583 

50.46 

14 

2.40 

(?) 

(?) 

No  available  record  of  cases. 

443 

18.94 

(?) 

Wyoming 

(?) 

(?) 

No  available  record  of  cases. 

Total 

30,352 

415 

'Based  upon  the  estimated  population  July  1,   1909,  as  given  by  the  Director  of  the  Census. 


148  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

Table  No  2. — Showing  Cases  Reported  by  Months.1 


Jan. 

Feb. 

Mar 

Apr. 

May 

June 

July 

Aug.  l   Sept. 

Oct. 

Nov. 

Dec. 

Total 

Colorado  .  . 

Florida  .  .  . 

Illinois  .... 

Indiana  . .  . 

Iowa  

Kansas  .... 

Maine  .... 

Maryland  . 

Massa- 
chusetts 

Michigan  . 

Montana  .  . 

New 
Hampshire 

New  Jersey 

New  York. 

North 

Carolina. 

North 

Dakota. . 

Ohio  

Oklahoma 

Oregon  .  .  . 

Penn- 
sylvania. . 

Utah  

Washington 
Wisconsin 

82 
50 
170 
189 
122 
441 
... 

90 
290 
122 

4 

"si 

877 

46 
104 
238 

36 

14 
706 
181 
120 

39 

3973 

132 

61 

32 

92 

109 

280 

6 

26 
262 
116 

3 

2 

50 

758 

32 

83 

388 

29 

41 
785 
91 
82 
63 

3523 

179 
213 

88 
104 

97 
256 

5 

356 

68 

1 

69 

429 

107 
60 

390 
29 

40 

581 

112 

60 

66 

3310 

114 
118 

58 

92 

141 

148 

i 

4 

253 

64 

"(ii 

317 

14 

77 

475 

12 

8 

228 

79 

78 

33 

117 

180 

74 

98 

68 

304 

1 

3 

10 

370 

70 

3 

55 

249 

22 
178 
214 

12 

22 

199 

64 

54 
50 

2417 

68 
162 
92 
82 
76 
247 

7 

316 

53 

2 

41 

219 

20 
168 
267 

14 

7 

246 

27 

36 

37 

62 
81 
24 

"23 

43 

1 

2 

104 

33 

2 
10 

115 

6 

46 
69 

23 
42 
21 
15 
32 

754 

14 

28 

16 

6 

17 
20 

65 

8 

3 

10 

91 

38 

4 

51 

4 
17 
11 

4 
10 

|  417 

39 
17 
8 
1 
9 
9 

32 
15 

4 
1 

45 

2 

8 

65 

12 

6 
8 

42 

7 

12 

342 

73 
11 
52 
2 
12 
66 

101 

18 

3 
1 

197 

3 
11 
46 

7 

32 

35 

5 

14 

689 

112 

107 

84 

53 

50 

211 

1 

339 
17 

"2 

244 

9 

8 

48 

2 

1 
28 
91 
41 
37 

1485 

104 
258 
32 
45 
126 
177 

97 

50 

3 
2 
2 

740 

7 

12 
91 
11 

2 

53 
212 

81 
50 

2155 

1,096 

1,286 

730 

764 

850 

2,202 

8 

6 

144 

2,585 

634 

10 

22 

353 

4,281 

306 

759 

2,342 

164 

168 
2,925 
966 
583 
443 

Total.. 

2375 

2187 

23,627 

Pellagra. — Pellagra  is  a  disease  which  was  not  known  to  exist  in  the  United 
States,  with  the  exception  of  an  occasional  isolated  case,  until  the  year  1907. 
If  cases  existed  before  this  time,  they  were  not  recognized.  Since  1907,  how- 
ever, cases  have  been  found  in  considerable  numbers  in  many  localities.  It 
continues  to  be  prevalent  to  an  unexpected  extent,  and  an  increasing  number 
of  cases  are  being  recognized  as  practicing  physicians  become  familiar  with  the 
symptoms  of  the  disease.  Its  exact  prevalence  is  not  known,  although  it  has 
been  found  in  more  than  thirty  States.  The  disease  is  undoubtedly  one  which 
is  frequently  not  properly  diagnosed.  It  is  at  present  required  by  law  to  be 
reported  in  only  four  States. 

Leprosy. — Occasional  cases  of  leprosy  are  found  in  the  United  States.  They 
are  usually  among  the  foreign  born,  although  cases  have  been  reported  among 
the  native  born.  From  January  1  to  September  1,  1911,  nine  cases  have 
been  reported  from  seven  States  and  the  District  of  Columbia. 

Plague. — From  July  1,  1909,  to  August  8,  1911,  seven  cases  of  plague  have 
been  reported  in  the  State  of  California.    These  occurred  as  follows: 

October  26th  1  case 

August  2d   1 

September  24,  1909 1  " 

June    5th    1  " 

September   5,    1910 1  " 

July   25,    1911 1  " 

August   8,    1911 1  " 

Beriberi. — Occasional  outbreaks  of  this  disease  have  been  reported  as  follows : 
In    South   Carolina,   among   negro   convicts,   at   a  camp   ten   miles    from   the 

city  of  Charleston,  seventeen  cases,  with  eight  deaths. 

In  California  during  the  years  1907,  1908  and  1909,  twenty-five  deaths  from 

beriberi  were  reported.    Of  these,  twenty-two  were  of  Japanese,  two  of  Chinese 

and  one  of   German  nativity. 


"This  table  includes  only  the  States  for  which  the  cases  were  reported  bv  months. 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  149 

A  series  of  seventy-one  cases  was  reported  among  the  patients  in  the  State 
Insane  Asylum,  Tuscaloosa,  Alabama,  during  the  years  1895  and  1896.  Of 
these  twenty-one  were   fatal. 

In  1907  over  two  hundred  cases  developed  in  the  State  Lunatic  Asylum, 
Austin,   Texas.     Of   these,   twenty  were   fatal. 

MORTALITY. 

The  data  available  in  regard  to  vital  statistics  refers  mostly  to  the  year 
1909,  the  Bureau  of  the  Census  not  having  yet  made  public  the  bulletin  con- 
taining the  mortality  statistics  for  the  year  1910.  Through  the  courtesy  of  the 
Chief  Vital  Statistician  of  the  Census  Bureau,  some  advance  information  rela- 
tive to  mortality  rates  of  the  most  important  diseases  in  the  year  1910  is 
also  incorporated  in  this  report. 

The  population  of  the  "registration  area"  of  the  United  States,  which  was 
estimated  to  comprise  in  1908  a  total  of  about  45,000,000  inhabitants,  was 
increased  in  both  1909  and  1910  by  the  addition  of  further  sections  of  the 
country  complying  with  the  requisites  of  the  Census  Bureau.  The  percentage 
of  population  in  the  "registration  area"  thus  rose  from  51.8  in  1908  to  55.3 
in  1909  and  58.3  in  1910.  Laws  recently  adopted  in  various  States  make  it 
very  probable  that  this  area  will  soon  receive  further  substantial  additions. 

For  the  year  1909  the  registration  area  of  the  United  States  included  the 
following  States:  California,  Colorado,  Connecticut,  Indiana,  Maine,  Mary- 
land, Massachusetts,  Michigan,  New  Hampshire,  New  Jersey,  New  York, 
Ohio,  Pennsylvania,  Rhode  Island,  South  Dakota,  Vermont,  Washington,  Wis- 
consin, and  54  cities  in  non-registration  States.  Minnesota,  Missouri,  and 
North  Carolina  (only  cities  over  1,000  inhabitants)  were  the  States  admitted 
to  the  registration  area  in  1910. 

The  total  number  of  deaths  returned  from  the  year  1909  was  732,538,  and 
for  1910,  805,412.  The  death  rate  for  1909  was  15  per  1,000  and  14.95  per 
1,000  in  1910,  a  mortality  which  compares  very  favorably  with  that  for  the 
year   1908    (15.4). 

Of  the  deaths  registered  for  the  year  1909,  54.4%  were  deaths  of  males, 
a  rate  practically  identical  with  that  for  1908  (54.3%).  There  was  a  slight 
decrease  in  the  proportion  of  deaths  of  children  under  5  years  of  age,  26.8% 
in  1909  to  27.5  in  1910,  this  being  mostly  due  to  a  lower  ratio  of  deaths  of 
infants  under  1  year  in  1909  (19.1)  than  in  1908  (19.7).  The  quinquennial 
percentages  up  to  and  including  45  to  49  years  are  either  the  same  for  1909 
and  1908  or  a  trifle  lower  in  1909,  thus  making  the  proportion  for  the  higher 
ages  greater  in  1909  than  in  1908.  196,534  of  the  deaths  occurred  in  children 
under  5  years  of  age,  and  140,057  of  these  were  of  infants  under  1  year. 

The  death  rates  of  the  larger  American  cities  for  the  year  1909  vary  for 
the  most  part  between  14  and  17  per  thousand,  and  are  about  2  or  3  per  1,000 
lower  than  they  were  ten  years  ago.  The  precise  figures  are,  however,  sub- 
ject to  revision,  as  they  are  based  on  estimated  populations: 

jqo8  igog 

New  York   16.8  16.0 

Chicago     14.0  14.6 

Philadelphia    17.4  16.4 

Boston     19.1  16.8 

New   Orleans    22.7  20.2 

St.  Louis   14.5  15.8 

Pittsburgh     16.5  15.8 

Baltimore   18.3  18.7 

Washington,  D.  C 19.3  19.0 

Detroit    15.6  14.0 

Milwaukee  13.6  13.6 

Indianapolis     13.5  11.4 

Jersey   City    17.8  16.8 

Buffalo    15.9  15.2 

Cleveland    14.2  12.9 

Cincinnati     18.5  16.4 


150  FIFTH    INTERNATIONAL   SANITARY   CONFERENCE. 

The  cities  with  the  largest  amounts  of  decrease  in  the  actual  number  of 
deaths  returned  in  1909  as  compared  with  the  year  1908  were  Philadelphia 
(987);  Boston  (696);  Pittsburgh  (687);  New  Orleans  (575),  and  Cincinnati 
(512).  The  continued  decrease  in  the  number  of  deaths  in  Philadelphia  is 
worthy  of  notice,  the  decrease  for  the  year  1908  as  compared  with  1907  having 
been  1,550. 

CAUSES    OF    DEATH. 

No.  of  deaths  Death  rate  per  wofioo 

1909  19 10  1908  1909  1 010 

Typhoid    fever    10,722  12.673  25.3  21.1  23.5 

Malaria    1,175  1,176  2.5  2.4  2.2 

Smallpox   79  202  0.2  0.2  0.4 

Measles    4,860  6,598  10.2  10.0  12.3 

Scarlet  fever    5,781  6.255  12.4  11.0  11.6 

Whooping  cough    4,906  6,146  11.0  10.1  11.4 

Diphtheria    and    croup 10,358  11,521  22.3  21.2  21.4 

Tuberculosis,  all   forms 81,720  86,309  173.9  167.5  160.3 

Cancer    37,562  41,039  74.3  77.0  76.2 

Rheumatism    3,633  4.004  7.9  7.4  7.4 

Diabetes  7.024  8,040  13.9  14.4  14.9 

Meningitis     7,853  7,619  19.8  16.1  14.2 

Heart   disease    65,971  76,178  133.3  135.3  141.5 

Bronchitis   12,127  12,620  26.9  24.9  23.4 

Pneumonia    70,033  79,524  136.0  143.6  147.4 

Diarrhea  and   enteritis    (inf.) 44,648  54,266  98.9  91.5  100.8 

Appendicitis    5,768  6,128  11.7  11.8  11.4 

Bright's   disease    48,430  53,330  97.3  99.3  99.0 

Puerp.  affections  7,791  7.455  16.3  16.0  15.7 

Suicide   8.402  8.590  18.5  17.2  16.0 

Accidents  (including  violent  deaths)  47,135  48,606  97.9  99.7  90.3 

The  twenty  leading  causes  of  death  for  1909  in  the  order  of  the  number  of 
deaths  caused  were : 

Tuberculosis  81,720 

Heart   disease    65,971 

Diarrhea  and  enteritis    52,516 

Pneumonia    49,007 

Bright's   disease    (and  nephritis) 48,430 

Accident     44,281 

Cancer    37,562 

Apoplexy     36,463 

Broncho-pneumonia   21,026 

Premature  birth   18,286 

Congenital    debility    14,988 

Old  age  13,456 

Bronchitis    12,127 

Tvphoid  fever  10,722 

Diphtheria  _ 10,358 

Diseases  of  arteries    10,174 

Suicide 8,402 

Various  diseases  of  stomach 8,171 

Meningitis     7,853 

Childbirth    7,791 


POLIOMYELITIS   IN    THE   UNITED   STATES.' 

Cases  and  Deaths  Reported  During  the  Year  1910. 


Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

July. 

AuE. 

Sept. 

Oct. 

Nov. 

Dec. 

Total. 

Stale. 

O 

1 

o 

s 

™ 

| 

CJ 

1 

U 

| 

« 

1 

O 

_ 

3 

J 

O 

| 

™ 

0 

cj 

| 

!|I 

J 

| 

Remarks. 

1 

■   No  reports. 
Do. 

13 

4 
71 

2 

io' 

9 
1 

31 

3 

1 

11 

4 

5 
Mis 

l.lii 

1 

32 

1 

15 

December  report  not  yet  received . 
Reports  not  completed. 

I 

IS 
2 

I 

36 

'i 

2 

2 

1 

Do. 

113 

11 

20 
4 

2 

IS 
1 

1 

1 

No  reports. 

from  second  week  in  September 
to  Dec.  15,  1910.  there  were  42 

42 

93 
137 
13.1 
HIS 
IS!, 

1 

1: 
12 
2!l 
Mil 
17 

1 

1 

1 

5 

1 

II 

4 

16 

5 

23 

2 

33 

77 

111. 

18 
II 
32 

52 
611 
■13 

10 
11 
IS 

11 
ii 

i 
11 

3 

3 

1 

1 

4 

2 

T 

J 

25 

2 

20 

J 

51 
57 

7 
15 

156 

44 

Wa- 

39 

Up  to  Nov.  20, 1910, 1S9  cases  and 

47  deaths. 
Present— no  reports. 
No  reports. 

first   six  months   of   the  year- 
June  and  July  1910,  184  cases  re- 
ported;  deaths  not  given. 

1 

4 
3 

9 

1118 

7 
89 

III 

2 
13 

ll 

2114 

10 

77 

3 

4 
16 

7 

575 

10 

55 

6 

2 
3 

5 

54 

9 
6 

3 

1 

35 

588 

43 
227 

28 

14 
09 

8 

1 

2 

3 

8 

21 

7 

5 

Reports  lor  year  not  complete. 

January  to  June  1910, 36  deaths. 
No  reports. 

Do. 
Estimated  cases  40. 
No  reports. 
9  eases  with   1  death  during  the 

years  1909  and  1910. 

6 

5 

2 

5 
75 

2 

75  cases  during  the  year  from  55 

localities. 
No  reports. 

1 

1 

10 

28 

12 

97 

16 

l:l 

21 

.::: 

9 

4 

2 

517 

60 

No  reports. 

ii 

29 

1 

38 

1 

11 

24 

1 

10 
2S 

2 

1 

Mil) 

36 
,097 
231 

85 

80 

'4' 

21 

72 

10 

17 

Reports  not  complete. 

January  to  August  1910,    5   eases 

Ore  on 

2 

2 

18 

152 
46 

5 

275 
70 

1 

58 

378 
65 

1 

111 

5 

117 
9 

50 

9 

115 
1 

11 

22 

2 

15 
2 

1 

Reports  for  year  not  complete. 
During   the  year    a   total    of   231 

Cases  reported  between    May   21 
and  Oct.    15. 

1 

4 

5 

15 

1 

25 

11 

31 

3 

11) 

2 

5 

No  cases  reported. 
Do. 

2 

1 

2 
13 

357 

254 

1 
2 

2 

49 

3  cases,  2  deaths,  to  Oct.  1;  no 
cases  during  balance  of  year. 

Jan.  1  to  Oct.  12,  1910.  326  eases 
were  reported. 

Vi,   inia 

»30 
103 

15 

318 

19 
20 

1 
9 

12 

8 

1 

6 

1 

7 

24 

1 

40 

1 

51 

17 

22 

27 

Estimated  there  were  500  cases. 
No  reports. 

12 

3 

2 

1 

7 

2 

11 

3 

46 

2 

.'.7 

7 

465 

44 

,117:1 

82 

04 

76 

177 

11 

05 

3li 

,093 

25 

,146 

L71   i 

I  See  Public  Health  Reports,  Sept.  30.  1910,  p.  1317,  and  Oct,  23,  1910,  p.  1517 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  151 

DEATHS    BY    SEX    AND    AGE. 

Sex.  Percentage. 

Male    398,597  54.4 

Female     333,941  45.6 

Age. 

Under  5  years 196,534  26.8 

5  to  9  years 16,141  2.2 

10  to   14  years 10,761  1.5 

15  to  19  years 18,138  2.5 

20  to  24  years 27,303  3.7 

25  to  29  years 29,733  4.1 

30  to  34  years 29,905  4.1 

35  to  39  years 32,965  4.5 

40  to  44  years 32,115  4.4 

45  to  49  years 34,646  4.7 

50  to  54  years 36,428  5.0 

55  to  59  years 37,007  5.1 

60  to  64  years 42,475  5.8 

65  to  69  years 46,649  6.4 

70  to  74  years 45,610  6.2 

75  to  79  years 41,989  5.7 

80  to  84  years 29,680  4.1 

85  to  89  years 16,533  2.3 

'90  and  over,  and  unknown 7,925  1.0 

OCCUPATIONS   AND   CAUSES   OF   DEATH. 

An  effort  has  been  made  to  compile  data  relative  to  decedents  in  the  regis- 
tration area  who  were  at  least  ten  years  old,  and  were  reported  to  have  been 
engaged  in  some  gainful  occupation  at  the  time  of  their  death.  Of  the  deaths 
of  males  reported,  210,507,  or  52.8%,  were  of  persons  engaged  in  some  gainful 
occupation;  while  in  the  case  of  females,  27,459,  or  only  8.2%,  were  of  per- 
sons gainfully  employed. 

In  the  absence  of  definite  statistics  (which  are  only  available  every  ten 
years)  showing  the  number  of  persons  employed  in  the  different  industries,  the 
data  compiled  by  the  Census  Bureau  regarding  the  relative  mortality  of  various 
occupations  can  hardly  be  called  satisfactory,  as  more  or  less  guesswork  must 
figure  in  all  the  comparisons  made,  and  it  is  difficult  to  determine  the  whole- 
someness  of  a  given  industry  as  shown  by  the  death  rate. 

REGULATIONS    RELATIVE    TO    INTERNATIONAL    TRAFFIC    WITH    A    VIEW    TO    PREVENTING 
THE    SPREAD    OF    COMMUNICABLE   DISEASES. 

The  United  States  Quarantine  Regulations  outline  the  measures  which  have 
been  deemed  advisable  for  the  protection  of  the  nation  against  the  introduction 
of  communicable  diseases  in  international  traffic.  These  regulations  were  thor- 
oughly revised  in  October,  1910,  and  conform  strictly  to  the  principles  laid 
down  at  the  International  Sanitary  Conference  held  at  Paris  in  1903,  and  the 
Conventions  signed  by  the  American  Republics.  Their  application  in  the  daily 
practice  was  the  subject  of  a  paper  by  the  United  States  delegation  at  the 
Fourth  International  Sanitary  Conference  held  at  San  Jose,  Costa  Rica,  in 
1909  (see  page  196  of  the  Transactions). 

The  one  matter  of  supreme  importance  in  the  revision  of  the  regulations  was 
the  adoption  of  a  regulation  relative  to  the  destruction  of  rodents,  which  com- 
mits the  government  to  the  policy  of  systematic  fumigation  of  ships  every  six 
months  or  oftener.*  This  matter  has  been  brought  to  the  attention  of  the 
International  Office  of  Public  Hygiene  at  Paris,  and  it  is  expected  that  it  will 
be  one  of  the  subjects  under  consideration  at  the  International  Sanitary  Con- 
ference which  will  meet  at  Paris  in  October,  1911. 


*This   regulation   is   discussed   in   another   part  of  this  report,  and  a  copy  of  the  regulation 
itself  is  also  given  there. 


152  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

SANITARY   RESTRICTIONS   ON   IMMIGRATION. 

The  immigration  laws  of  the  United  States  exclude  from  admission :  idiots, 
imbeciles,  feeble-minded  persons,  epileptics,  insane  persons,  persons  afflicted 
with  tuberculosis  or  with  a  loathsome  or  dangerous  contagious  disease,  and  also 
persons  afflicted  with  a  mental  or  physical  defect  of  such  nature  as  to  affect 
the  ability  of  the  alien  to  earn  a  living. 

Officers  of  the  Public  Health  and  Marine  Hospital  Service  conduct  the  medi- 
cal examinations  of  aliens,  and  pass  upon  questions  of  a  medical  character 
arising  in  the  enforcement  of  this  act.  The  regulations  prepared  by  this 
Service  define  a  loathsome  contagious  disease,  and  refer  especially  to  those 
essentially  chronic  in  character,  such  as  favus,  ringworm,  sycosis  barbae,  acti- 
nomycosis, blastomycosis,  frambesia,  mycetoma,  leprosy,  and  venereal  diseases. 
A  dangerous  contagious  disease  is  taken  to  mean  a  communicable  disease, 
essentially  chronic  in  character,  which  may  result  in  the  destruction  of  one  of 
the  most  important  senses  or  loss  of  life,  such  as  trachoma,  filariasis,  uncina- 
riasis, amoebic  infection,  bilharziosis. 

Cases  which  are  considered  to  fall  under  the  classification  of  "persons  afflicted 
with  a  mental  or  physical  defect  of  such  nature  as  to  affect  the  ability  of 
the  alien  to  earn  a  living"  are  such  diseases  as  hernia,  heart  disease,  defective 
nutrition,  defective  development,  chronic  arthritis  and  myositis,  nervous  affec- 
tions, malignant  new  growths,  deformities,  senility,  varicose  veins,  defective 
eyesight,  cutaneous  affections,  eruptive  fevers,  anaemia,  tuberculosis  joint  affec- 
tions, and  conditions  such  as  pregnancy,  and  in  general  all  diseases  and  defects 
that  may  impair  a  person's  capacity  for  self-maintenance,  all  defective  and 
diseased  conditions  of  a  more  or  less  permanent  character  tending  to  require 
institutional  care  or  treatment,  all  physical  conditions  which  require  or  are 
likely  to  require  medical  treatment,  and  all  cases  of  diseased,  deformed,  or 
crippled  children. 

Many  of  the  immigrants  are  inspected  at  foreign  ports,  but  the  chief  reliance 
is  placed  on  the  examination  at  the  port  of  arrival.  These  examinations  are 
now  conducted  at  79  stations,  77  medical  officers  having  been  assigned  exclu- 
sively to  this  work  during  the  fiscal  year  1910.  There  were  1,280,957  immi- 
grants examined,  of  which  30,780  were  certified  for  exclusion  by  the  immigra- 
tion authorities. 


REPORT  PRESENTED  BY  DOCTOR  E.  FERNANDEZ  ES- 
PIRO  AND  DOCTOR  JAIME  H.  OLIVER,  DELEGATES 
FROM  URUGUAY. 

I.     LAWS   OF    SANITARY   POLICE  AND    HEALTH    MEASURES    ADOPTED    SINCE   THE   FOURTH 

CONFERENCE. 

The  following  laws  have  been  enacted  since  the  Fourth  International  Sani- 
tary Conference,  held  in  San  Jose,  Costa  Rica,  in  1909 : 

Law  creating  the  Departmental  Offices  of  Health  Inspection,  in  lieu  of  the 
Departmental  Boards  established  in  1895  under  the  National  Board  of  Hygiene; 
there  is  one  for  each  Department  of  the  Republic,  under  competent  physicians 
appointed  by  the  Executive  upon  recommendation  of  the  National  Board. 

Law  of  National  Public  Assistance.  Under  this  law,  all  national  and 
municipal  establishments  devoted  to  the  care,  protection  and  attendance  of  the 
poor  have  been  placed  under  the  control  of  the  Bureau  of  National  Public 
Assistance  and  the  Board  of  Public  Assistance,  which  latter  is  composed  of  21 
members.     The  former  is  under  a  Director-General. 

Law  of  Pharmacies,  which  prescribes  the  conditions  and  requirements  which 
must  be  fulfilled  for  the  operation  of  these  establishments.  No  drug  store  can 
now  be  operated  unless  it  be  under  a  graduate  pharmacist. 

Law  of  Vaccination  and  re- Vaccination,  which  compels  every  inhabitant  of 
the  Republic  to  be  duly  vaccinated. 

The  Economico-Administrative  Board  of  Montevideo  has  also  enacted  the 
following  health  ordinances :  Regulating  the  sale  and  distribution  of  milk ; 
regulating  the  use  of  coloring  matters  in  the  manufactory  of  foodstuffs,  papers 
and  cardboards. 

II.     COMPLIANCE   WITH    THE   RESOLUTIONS   PASSED   BY   THE   FIRST    FOUR   CONFERENCES. 

The  Government  of  Uruguay  has  not  overlooked  the  resolutions  passed  by 
the  Sanitary  Conferences,  since  both  the  international  and  domestic  laws  of 
the  country  are  in  accordance  with  the  fundamental  principles  of  said 
resolutions. 

In  support  of  this  suffice  it  to  say  that  the  International  Sanitary  Convention 
of  Rio  de  Janeiro  has  recognized  the  advisability  of  shortening  the  period  of 
detention  of  passengers  and  of  the  disinfection  of  baggage,  in  the  same  manner 
as  it  was  recognized  by  the  second  resolution  of  the  First  Sanitary  Conference 
of  Washington  of  1902.  On  the  other  hand,  the  National  Board  of  Hygiene 
has  adopted  the  recommendations  of  the  6th  resolution  of  the  same  conference 
as  to  the  immediate  disinfection  of  discharges  from  cholera  patients.  The 
same  body  has  also  taken  into  consideration  the  2d  resolution  of  the  Third 
International  Sanitary  Conference  as  to  the  codification  of  all  sanitary  laws 
and  measures,  recommending  the  legislature  of  the  Republic  to  appoint  a  com- 
mission charged  with  the  compilation  of  such  legislation.  The  commission  was 
duly  appointed  and  will  surely  have  its  work  completed  before  the  convening 
of  the  Sixth  Sanitary  Conference. 

With  reference  to  the  5th  resolution  of  the  Third  Conference,  we  have  to 
state  that  it  has  been  complied  with  by  the  law  of  compulsory  vaccination 
referred  to. 

The  17th  resolution  of  the  same  conference,  recommending  the  advisability 
of  isolating  consumptives,  has  been  fulfilled  by  the  Bureau  of  Public  Assistance 
by  ordering  that  such  patients  be  gathered  in  the  Fermin  Ferreira  Hospital, 
which  has  at  present  about  300  patients,  and  which  will  later  have  a  capacity 
for  700. 

Paragraph  (d),  Resolution  II  of  the  Fourth  Conference  has  been  put  into 
practice  with  the  order  of  the  Bureau  of  Health  of  Montevideo,  to  the  effect 


154  FIFTH   INTERNATIONAL   SANITARY   CONFERENCE. 

that  rats  be  captured  in  different  parts  of  the  capital  and  examined  in  the 
municipal  bacteriological  laboratory  for  the  purpose  of  ascertaining  the  pres- 
ence of  plague. 

Paragraph  (d),  Resolution  III  of  the  same  Conference  has  also  been  com- 
plied with,  because  the  sanitary  authorities  in  the  port  of  Montevideo  enforce 
the  medical  inspection  of  ships  at  all  times. 

Resolution  X  has  also  been  put  into  practice  by  sending  to  this  Conference 
a  delegate  who  had  participated  in  a  former  conference. 

As  to  Resolution  XI,  we  shall,  in  part  IV  of  this  report,  state  the  reasons 
why  no  information  has  been  furnished  to  the  International  Sanitary  Bureau 
of   Washington. 

III.  REPORT  ON  THE  ADOPTION  OF  THE  WASHINGTON  CONVENTION  OF  1905  AND  THE 
RATIFICATION  OF  ART.  IX  THEREOF  AS  RECOMMENDED  BY  THE  FOURTH  CONFER- 
ENCE AND  THE  PAN  AMERICAN  CONFERENCE  OF  BUENOS   AIRES. 

When  the  Third  International  Sanitary  Conference  of  Mexico  took  place, 
the  Uruguayan  Delegate  accepted  on  behalf  of  his  Government  and  signed 
ad  referendum  the  Sanitary  Convention  signed  at  Washington  in  1905.  This 
convention  has  been  submitted  to  the  Legislature  for  its  approval.  Therefore, 
we  expect  it  will  soon  be  a  law  of  the  Republic,  and  likewise,  Article  IX  thereof 
as   amended  by  the  Fourth   Conference.  , 

IV.     CONSTITUTION    AND    WORK    OF   THE    INTERNATIONAL    SANITARY    INFORMATION 

COMMISSION. 

The  constitution  and  establishment  of  the  Information  Sanitary  Bureau  of 
Montevideo  had  to  be  postponed  through  unforeseen  circumstances,  and  it  was 
only  in  December,  1910,  that  it  took  place.  The  Executive  appointed  the  fol- 
lowing persons  to  constitute  the  same :  Dr.  Joaquin  de  Salterain,  Dr.  Julio 
Etcharpe,  and  Dr.  Ernesto  Fernandez  Espiro.  Upon  request  of  the  Commis- 
sion, the  Minister  of  Foreign  Affairs  advised  the  Sanitary  Bureau  of  Wash- 
ington and  the  American  Governments  of  the  organization  of  the  commission, 
under  date  of  May  2,  1911,  but  up  to  this  date  the  Montevideo  Bureau  has 
received  no  communications  from  the  Washington  Bureau. 

This  is  the  best  opportunity  to  request  the  Delegates  from  the  countries 
interested  to  request  their  Governments  to  send  the  necessary  information  to 
the  bureaus   of   Montevideo  and  Washington. 

V.     SANITATION    OF    CITIES. 

In  the  Third  Conference  of  Mexico  we  stated  that  the  Government  had 
issued  a  decree  in  July,  .  1907,  providing  that  studies  and  surveys  be  made 
for  sanitation  works  in  rural  towns  and  cities.  Those  studies  and  surveys  have 
now  been  completed,  as  well  as  the  projects  of  the  works  that  are  to  be 
undertaken. 

The  purpose  of  the  Government  in  this  important  subject  has  been  to  provide 
those  cities  and  towns  with  the  best  possible  water  supply  and  sewerage 
systems.     The  total  costs  of  these  works  will  amount  to  $17,000,000  gold. 

VI.     PROPHYLACTIC     MEASURES    AGAINST    CHOLERA,    YELLOW    FEVER    AND    PLAGUE. 

These  diseases  are  entirely  exotic  in  Uruguay.  Whenever  any  cases  have 
occurred,  they  were  imported  from  abroad  and  always  through  the  maritime 
way. 

The  prophylactic  measures  enforced  in  Uruguay  against  palgue  are  in 
accordance  with  the  Convention  of  Rio  de  Janeiro  of  1904,  between  the  Argen- 
tine Republic,  Brazil,  Paraguay  and  Uruguay,  which  has  established  as  the 
three  fundamental  principles  in  matters  of  international  sanitary  police,  the 
following:  1st.  Not  to  interrupt  communication  with  any  country,  by  closing 
ports  or  establishing  sanitary  cordons  in  frontiers;  2d.  Not  to  reject  any  vessel, 
whatever  its  sanitary  condition;  3d.  To  enforce  prophylactic  measures,  the 
isolation  of  sick  or  suspected,  the  disinfection  of  ships  and  baggage,  sanitary 
inspection  of  vessels,  sanitary  surveillance,  and  preventive  vaccination. 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  155 

There  is  the  Isla  de  Flores,  a  well-equipped  Sanitary  Station,  with  a  lazaretto 
for  the  observation  of  sick  and   suspected  passengers. 

For  the  extermination  of  rats,  there  are  enforced  in  Uruguay  the  general 
provisions  of  the  Rio  de  Janeiro  Convention  and  of  the  Plan  of  Sanitary 
Maritime  Defense  against  Plague  issued  by  the  National  Board  of  Hygiene, 
which  provides  in  Section  11  that  when  plague  should  appear  in  a  maritime 
port  of  the  Republic,  no  vessel  coming  therefrom  shall  be  allowed  to  unload 
unless  it  has  been  previously  rid  of  rats.  In  September,  last,  the  Board  of 
Directors  of  the  Port  of  Montevideo  began  the  enforcement  of  a  plan  for  the 
systematic  destruction  of  rats.  The  author  of  said  plan  is  Dr.  Jaime  H. 
Oliver,  a  Director  of  the  Port.  On  the  other  hand,  the  municipal  Government 
of  the  Capital  has  a  brigade  of  inspectors  charged  with  the  duty  of  inspecting 
all  buildings  and  destroying  the  rats  therein. 

Among  the  diseases  classed  as  exotic  by  the  Maritime  Sanitary  Regulations, 
there  is  beri-beri,  which  does  not  exist  in  any  section  of  our  territory.  The 
only  cases  observed  have  come  through  seaports,  and  in  accordance  with  the 
said  regulations,  they  have  been  confined  and  isolated  in  the  lazaretto  of  the 
Isla  de  Flores,  where  they  were  retained  until  the  departure  of  the  vessel 
importing  them.  During  the  last  four  years  only  64  cases  have  been  recorded 
in  that   lazaretto. 


VII.     PROPHYLAXIS     OF     TRACHOMA,     LEPROSY,     VENEREAL     DISEASES,     SMALLPOX     AND 

TUBERCULOSIS. 

In  the  report  presented  to  the  Third  Conference  of  Mexico,  it  was  stated 
that  the  cases  of  trachoma  observed  by  the  occulists  in  Uruguay,  were  isolated 
cases  which  had  not  constituted  i'ocii  of  infection,  and  that  only  in  the 
Foundling  and  Orphan  Asylum  of  Montevideo  there  were  some  cases  which 
tended  to  disappear,  thanks  to  isolation. 

We  will  now  state  that  almost  all  the  children  lodged  in  that  asylum  were 
suffering  from  granular  conjunctivitis.  Energetic  isolation  measures  were 
enforced,  and  thanks  to  them  no  new  cases  have  occurred.  The  disease  would 
have  disappeared  entirely  had  it  not  been  for  the  fact  that  from  time  to  time 
new  children  are  admitted  who  are  afflicted  with  the  disease.  At  present  the 
total  number  of  trachoma  patients  in  the  asylum  is  40.  According  to  the  obser- 
vations of  occulists,  trachoma  occurs  with  some  frequency  in  Montevideo,  and 
also  among  foreign  immigrants. 

Leprosy  is  a  disease  rare  in  Uruguay.  As  all  physicians  are  compelled  to 
report  all  cases  coming  under  their  observation,  we  have  very  complete  statistics 
of  the  cases  of  leprosy.  During  the  period  of  13  years,  from  1898  to  1910, 
215  cases  have  been  reported,  according  to  the  records  of  the  National  Council 
of  Hygiene. 

Venereal  diseases. — In  the  year  1903  the  National  Council  of  Hygiene  was 
authorized  to  prepare  the  Regulations  governing  prostitution,  the  inspection  of 
which  was  under  the  control  of  the  Department  of  Police.  Prostitution  is  now 
regulated  upon  the  following  basis :  Elimination  of  districts,  and,  therefore, 
toleration  of  disseminated  prostitution ;  compulsory  registration  of  all  women 
engaged  in  the  practice;  medical  inspection  twice  a  week;  use  of  a  book  of 
identification,  wherein  are  recorded  all  medical  inspections  and  the  sanitary 
condition  of  each  woman ;  prohibition  to  attend  cafes,  bars,  etc. 

As  a  complement  to  the  service  of  medical  inspection,  there  is  a  Dispensary 
for  Prostitutes,  at  the  head  of  which  are  two  physicians. 

The  elimination  of  clandestine  prostitution  is  entrusted  to  the  Department 
of   Police. 

Prostitutes  suffering  from  venereal  diseases  are  confined  in  the  Doctor  Ger- 
man Segura  syphylocomium,  at  the  head  of  which  is  a  Medical  Director,  with 
an  assistant,  under  the  control  of  the  National  Board  of  Hygiene.  Very  soon 
there  will  be  a  new  building  with  capacity  for  150  patients,  costing  $300,000, 
gold.  The  medical  inspection  of  prostitutes  is  made  by  seven  physicians  for 
the  capital ;  two  for  the  syphylocomium,  and  two  for  the  Dispensary. 

During  the  five  years  that  the  syphylocomium  has  been  in  operation  the 
following  cases  have  been  treated : 


156  FIFTH   INTERNATIONAL  SANITARY  CONFERENCE. 

1906.  1908. 

Syphilis    95  Syphilis    60 

Chancres   18  Chancres   26 

Gonorrhea    266  Gonorrhea    379 

Other  diseases  29  Other  diseases  42 

1907.  1909. 

Syphilis    75  Syphilis    34 

Chancres   30  Chancres   44 

Gonorrhea     211  Gonorrhea  191 

Other  diseases  54  Other  diseases  47 

1910. 

Syphilis    82 

Chancres    52 

Gonorrhea     271 

Other  diseases  76 

It  should  be  noted  that  there  are  included  in  those  totals  women  from  the 
various  Departments  of  the  Capital,  in  whose  towns  and  cities  inspection  of 
prostitutes  is  also  enforced. 

Smallpox. — To  the  prophylactic  measures  against  this  disease,  mentioned  in 
the  report  to  the  Third  Conference,  there  should  be  added  the  law  of  vaccina- 
tion and  re-vaccination  above  referred  to. 

During  the  period  of  10  years,  from  1901  to  1910,  421,707  inoculations  have 
been  made  by  the  corps  of  official  vaccinators.  The  number  of  vaccinations  is 
really  greater,  because  private  physicians  do  a  considerable  amount  of  in- 
oculations. 

The  vaccine  used  in  Uruguay  is  manufactured  by  the  Municipal  Institute  of 
Vaccine,  and  obtained  from  tuberculine-tested  heifers.  The  number  of  tubes 
distributed  by  the  Institute  in  1910  was  236,240,  as  against  96,278  in  1909. 
From  1901   to   1910,  it  has  distributed  797,771   tubes. 

Tuberculosis. — In  addition  to  the  measures  set  forth  in  the  report  to  the 
Third  Conference,  there  are  enforced  the  provisions  of  new  laws,  such  as  the 
ordinance  providing  for  the  inspection  of  dairies,  and  the  law  of  1910  estab- 
lishing the  tuberculization  service  and  animal  veterinary  inspection,  under 
the  Bureau  of  Animal  Sanitary  Police.  All  milch  cows  are  inoculated  with 
tuberculine. 

In  August,  1908,  there  was  created  the  School  Medical  Corps,  which,  among 
other  duties,  is  charged  with  the  individual  examination  of  teachers,  pupils 
and  students  in  normal  schools.  In  this  examination  particular  attention  is 
given  to  tuberculosis.  Thus  we  have  been  able  to  find  among  476  teachers 
examined,  77  suffering  from  pulmonar  consumption.  All  those  found  thus 
afflicted  are  isolated  until  cured  or  retired. 

Summer  colonies  are  being  organized,  one  being  already  in  operation,  for 
sick  children  from  the  Foundling  and  Orphan  Asylum  and  for  those  selected 
by  the  School  Medical  Corps.  This  colony  is  giving  splendid  results  in  the 
fight  against  consumption,  as  are  also  the  new  pavillions  for  consumptives  in 
the  Fermin  Ferreira  Hospital. 

Independently  from  the  Government,  there  is  an  anti-tuberculosis  league, 
founded  by  Dr.  Joaquin  de  Salterain,  which  has  four  magnificent  dispensaries 
in  the  Capital,  specially  built  for  that  purpose. 

The  31st  of  August,  last,  was  designated  as  "tuberculosis  day,"  during  which 
there  were  received  voluntary  subscriptions  from  all  over  the  country  amount- 
ing to  $85,000  gold.  The  league  is  now  building  an  "Open-Air  Cure  Hospital" 
on  a  large  tract  of  land  beautifully  located  in  the  outskirts  of  the  city. 

Malaria  is  a  disease  unknown  in  our  country.  It  is  very  rarely  observed 
among  foreigners. 


FIFTH   INTERNATIONAL  SANITARY  CONFERENCE.  157 

VIII.  STATISTICS    ON    MORBIDITY    AND    MORTALITY,   AND    REPORT    UPON    THE    ADOPTION 

OF  THE   BERTILLON    NOMENCLATURE. 

The  statistical  data  that  we  present  before  this  Conference  refer  exclusively 
to  the  contagious  diseases  which  occur  most  frequently  in  the  Republic.  We 
shall  give  below,  by  periods  of  five,  from  1896,  the  statistics  of  cases  and 
deaths.  Comparing  this  table,  it  is  seen  that  the  largest  number  of  cases 
belongs  to  tuberculosis,  measles  and  typhoid  fever,  and  that  the  largest  of 
deaths  was  caused  by  tuberculosis,  measles  and  smallpox. 

1896-1900  1901-1905  1906-1910 

Cases.  Deaths.  Cases.  Deaths.  Cases.  Deaths. 

Measles    3,798        372  4,059        197  6,128        212 

Diphtheria   1,422        614  1,216        281  1,545        229 

Whooping  cough  702        243  768        186  647        190 

Tuberculosis   2,375     4,539*  5,965     4,785  6,158     5,958 

With  regard  to  the  adoption  of  the  Bertillon  Nomenclature,  we  have  to  state 
that  it  has  been  in  force  in  Uruguay  since  1901. 

*The  greater  number  of  deaths  is  due  to  the  fact  that  the  reporting  of  cases 
was  enforced  only  from  the  second  period  of  five  years. 

IX.  INSPECTION    OF    INTERNATIONAL   TRAFFIC  BOTH    BY   LAND   AND    SEA    IN    CASES    OF 

TRANSMISSIBLE   OR    QUARANTINABLE   DISEASES. 

The  supreme  authority  charged  in  Uruguay  with  the  enforcement  of  the 
provisions  above  set  forth,  is  the  National  Board  of  Hygiene,  created  by  the 
law  of  October  31,  1895,  and  clothed  with  ample  powers.  It  is  composed  of 
seven  members  appointed  by  the  Executive.  Its  chairman  is  the  supreme  chief 
of  the  whole  sanitary  service  of  the  Republic.  In  each  Department  there  is  one 
Departmental  Hygiene  Inspector  and  a  Departmental  Board  of  Hygiene.  In 
Montevideo  there  is  also  a  Bureau  of  Maritime  Sanitary  Inspection  with  a 
Medical  Director  and  three  maritime  physicians,  whose  special  duty  it  is  to 
prevent  the  introduction  of  exotic  and  infectious  disease.  According  to  the 
Maritime  Sanitary  Regulations,  the  diseases  included  in  the  former  class  are: 
cholera,  yellow  fever,  beri-beri  and  plague,  and  in  the  latter  class,  typhus,  small- 
pox, scarlet  fever,  measles  and  diphtheria. 

The  maritime  sanitary  regulations  require  that  all  vessels  be  provided  with 
a  bill  of  health,  and  besides  every  ship  is  duly  examined  upon  arrival  by  a 
sanitary  inspector. 

Mention  has  been  made  of  the  Sanitary  Station  at  Isla  de  Flores,  provided 
with  a  lazaretto  for  infectious  diseases.  This  island  is  situated  outside  the 
port  of  Montevideo,  and  is  divided  in  two  sections,  one  for  healthy  passengers 
under  observation,  and  another  for  sick  passengers.  The  maritime  sanitary 
regulations  provided  that  all  passengers,  when  sick  or  convalescing  from  an 
exotic  or  infectious  disease  shall  be  confined  in  Isla  de  Flores. 

As  regards  our  land  frontiers,  we  have  no  inspection  over  the  international 
traffic,  and  only  in  case  of  an  epidemic  in  a  neighboring  country  do  we  enforce 
prophylactic  measures. 

X.     SANITARY  LAWS  ON   IMMIGRATION. 

The  immigration  law  of  Uruguay  was  enacted  in  1890,  for  the  purpose  of 
encouraging  the  introduction  of  immigrants  into  the  country.  Among  its  pro- 
visions, there  is  one  prohibiting  the  master  of  any  vessel  from  admitting  aboard 
ship  any  person  suffering  from  contagious  diseases,  or  is  poor,  or  over  sixty 
years  old,  or  physically  or  mentally  unable  to  work.  The  said  law  also  prohibits 
the  immigration  of  Asiatics,  Africans,  Hungarians  and  Bohemians. 


REPORT  PRESENTED  BY  DOCTORS  PABLO  ACOSTA 
ORTIZ  AND  LUIS  RAZETTI,  DELEGATES  FROM  VEN- 
EZUELA. 

.Honored  by  the  Government  of  Venezuela  with  its  representation  before 
this  learned  Conference,  we  beg  to  report  as  follows  upon  the  various  subjects 
of  the  Program: 

I.  Sanitary  police  laws  and  health  measures  adopted  in  each  country 

SINCE    THE    FOURTH    CONFERENCE. 

Organization  of  health  services.  By  a  presidential  decree  of  January  6, 
1910,  there  was  created,  a  dependency  of  the  Department  of  the  Interior,  the 
Bureau  of  Public  Hygiene  and  Health,  which  has  charge  of  all  matters  relating 
to  maritime  sanitary  police,  study  of  infectious  diseases,  sanitation  and  disin- 
fection works,   demographic   statistics,  leper  colonies,   insane   asylums,   etc. 

The  chief  of  this  bureau  is  the  National  Director  of  Public  Hygiene  and 
Health,  who  is  chairman  ex  officio  of  the  Supreme  Board  of  Health  and 
Hygiene,  whose  principal  function  it  is  to  legislate  upon  public  health  and 
hygiene  matters  which  may  be  referred  to  it  by  the  Executive. 

Under  the  Bureau  of  Public  Hygiene  and  Health  is  the  Technical  Division 
of  Hygiene,  divided  into  three  sections,  viz. :  infectious  diseases ;  chemistry 
and  bacteriology;  and  statistics  and  demography.  This  division  is  equipped 
with  complete  laboratory  of  hygiene,  which  is  provided  with  everything  neces- 
sary for  the  manufacture  of  serums  and  vaccines,  and  for  chemical  and  bac- 
teriological analysis.  A  special  department  of  the  laboratory  is  exclusively 
devoted  to  plague,  both  in  men  and   in  rodents. 

Besides  the  section  chiefs,  the  Division  has  medical  sanitary  officers,  house 
inspectors,  sanitary  policemen,  sanitary  squads,  etc. 

Special  health  tax. — By  decree  of  the  President,  dated  December  29,  1910, 
a  special  health  tax,  of  one  per  cent  of  the  total  value  of  customs  duties 
levied  on  merchandise  imported.  The  Chamber  of  Commerce  of  Caracas, 
constituted  as  Central  Board  of  Public  Health,  administers  these  funds,  which 
are  kept  in  the  Bank  of  Venezuela,  as  a  special  account  called  "Hygiene 
and  Sanitation  Funds,"  together  with  revenues  derived  from  the  inspection  of 
vessels,   disinfections,   etc. 

Sanitary  Organization  of  the  City  of  Caracas. — The  city  of  Caracas,  capital 
of  the  Republic,  is  divided  into  nine  Sanitary  Districts,  at  the  head  of  which 
is  a  Medical  Health  Officer.  The  personnel  consists  of  two  sanitary  inspectors 
for  each  district;  one  general  agent  of  sanitary  police,  and  five  subordinate 
agents  who  are  at  the  head  of  the  various  squads,  which  are  as  follows :  three 
for  petrolization ;  four  for  drainage;  three  for  destruction  of  mosquitoes,  and 
seven  for  destruction  of  rats  and  for  disinfection  in  general.  One  corporal 
has  immediate  charge  of  each  of  these  squads. 

There  is  also  a  special  department  of  the  Technical  Bureau  provided  with 
all  necessary  apparatus  and  instruments  for  disinfection,  and  with  a  personnel 
well  trained  for  the  performance  of  its  duties. 

Sanitary  Organisation  of  Ports. — The  ports  of  Venezuela  opened  to  foreign 
traffic  are :  La  Guaira,  Puerto  Cabello,  Carupano,  Ciudad  Bolivar,  Maracaibo, 
Cristobal  Colon,  Puerto  Sucre,  Pampatar,  and  La  Vela.  In  each  of  them 
there  is  a  Director  of  Health  whose  duties  are  provided  for  in  the  Maritime 
Sanitary  Police  Regulation  issued  on  June  4,  1909. 

La  Guaira  and  Puerto  Cabello,  the  principal  ports  of  the  Republic,  are  each 
equipped  with  a  bacteriological  laboratory  and  a  disinfection  station  with 
Clayton  apparatus.  Carupano  and  Ciudad  Bolivar  also  have  disinfection 
stations. 


160  FIFTH  INTERNATIONAL  SANITARY  CONFERENCE. 

Although  our  sanitary  organization  is  not  as  yet  perfect,  we  believe  that 
we  now  have  a  solid  basis  upon  which  to  build  an  excellent  health  service, 
which  will  soon  be  accomplished  through  the  keen  interest  the  present  adminis- 
tration takes  in  matters  of  public  hygiene. 

II.  Compliance  with  the  resolutions  passed  by  the  first  four  confer- 
ences. 

The  Government  of  Venezuela  has,  within  the  means  at  its  disposal,  complied 
with  the  Resolutions  of  the  Fourth  Conference.  Those  of  the  first  three  it 
has  accepted  in  principle,  they  being  of  real  benefit  to  the  public  health  of 
the  American  Continent. 

III.  Report  on  the  adoption  of  the  convention  of  Washington  of  1905, 

AND    THE    RATIFICATION    OF    ARTICLE    IX    AS    AMENDED    BY    THE    FOURTH     SANITARY 
CONFERENCE  AND  THE  PAN   AMERICAN   CONFERENCE  OF  BUENOS   AIRES. 

Venezuela  was  one  of  the  signatory  nations  to  the  Sanitary  Convention  of 
Washington. 

As  to  the  amendment  proposed  by  the  Fourth  Sanitary  Conference  and  the 
Pan  American  Conference  of  Buenos  Aires,  to  Article  IX  of  the  Convention 
referred  to,  we  will  take  the  liberty  to  make  the  following  remarks : 

1st.  The  text  of  said  article  should  be  carefully  studied  in  order  that  it  should 
be  clearly  and  precisely  termed.  The  periods  therein  fixed  to  consider  a 
locality  free  from  infection  are  not  in  conformity  with  every-day  observations. 
In  places  where  yellow  fever  and  plague  are  prevalent  it  is  noticed  that  periods 
of  from  one  to  more  months  may  elapse  without  the  occurrence  of  a  single 
case,  only  to  reappear  later,  although  all  necessary  measures  may  have  been 
enforced  and  continued  to  be  enforced  vigorously.  Such  disappearances  and 
reappearances  show  that  the  infected  locality  is  still  in  that  condition  even 
if  no  cases  occur  in  man,  that  is  to  say,  that  it  is  not  a  passing  epidemic,  but 
an  endemic.  Yellow  fever  in  some  American  countries  is  epidemic,  but  entirely 
endemic  since  time  immemorial.  Plague,  except  in  very  rare  cases,  such  as  that 
of  La  Guaira,  where  it  only  lasted  six  months,  is  a  disease  most  difficult  to 
fight,  because  the  extermination  of  rodents,  which  are  the  main  factor  in  main- 
taining the  state  of  infection,  is  an  arduous  task,  requiring  not  only  large 
amounts  of  money  but  also  a  long  time. 

What  can  be  the  meaning  of  the  "five  days"  prescribed  for  plague,  and  what 
that  of  "eighteen  days"  for  yellow  fever,  in  order  that  a  locality  may  be 
considered  free  from  infection  of  those  diseases,  when  we  all  know  that  new 
cases  may  appear  after  months  have  elapsed  since  the  last  case?  An  examina- 
tion of  statistical  figures  would  show  us  how  far  from  scientific  accuracy  is 
the  wording  of  the  now  famous  Article  IX  of  the  Washington  Convention. 

2d.  As  regards  the  amendment  thereto  suggested  by  the  Fourth  Conference, 
we  notice  that  the  words  "to  the  satisfaction  of  the  interested  party,"  instead 
of  elucidating  the  text  and  of  giving  a  precise  meaning  to  the  spirit  of  the 
article,  it  makes  its  interpretation  obscure  and  difficult.  Which  is  the  inter- 
ested party  when  a  country  is  unfortunate  to  have  been  invaded  by  an  epidemic 
disease?  We  suppose  it  is  the  neighboring  country  still  free  from  infection, 
or  both,  if  the  wording  were  to  be  "both  interested  parties."  But  then  the 
question  arises,  which  of  them  is  entitled  to  prescribe  the  extent  of  such 
satisfaction?  When  are  the  parties  to  declare  themselves  as  satisfied?  We 
know  that  plague  epidemics  are  intermittent  and  last  for  some  years  in  certain 
countries,  and  that  yellow  fever  is  endemic  in  some  American  Republics. 

For  the  above  reasons  we  believe  that  Article  IX  of  the  Washington  Con- 
vention should  be  carefully  considered  and  so  amended  as  to  be  in  accordance 
with  equity  and  justice  upon  which  the  relations  between  civilized  nations 
should  be  based. 

IV.  Constitution  and  work  of  the  sanitary  information  committees. 

The  Venezuelan  Committee  is  composed  of  Dr.  Carlos  M.  de  la  Cabada,  the 
Director  of  Public  Hygiene  and  Health,  and  Dr.  Luis  Razetti  and  P.  Acosta 


FIFTH  INTERNATIONAL  SANITARY  CONFERENCE.  161 

Ortiz,  Delegates  from  Venezuela  to  the  Fourth  and  Fifth  Sanitary  Conferences. 
Organized  in  due  time  this  Committee  has  performed  its  duties  regularly. 

V.  Sanitation  of  cities  and  specially  of  ports. 

The  sanitation  of  the  city  of  Caracas  urgently  calling  for  a  good  sewer 
system,  the  Government  of  the  Republic  entered  into  a  contract  with  an 
English  company,  whose  engineers  have  already  arrived  to  make  the  necessary 
surveys,  and  the  actual  work  of  construction  will  soon  be  started.  The  total 
cost  of  the  system  is  estimated  over  20,000,000  francs.  With  its  excellent 
climatic  and  topographic  conditions,  a  good  sewer  system  and  well  paved  streets, 
Caracas  will  be  one  of  the  healthiest  cities  in  the  Continent. 

VI.  Prophylactic  measures  against  plague,  cholera,  and  yellow  fever. 

A.   Measures  against  Plague. 

Under  the  General  Ordinance  for  the  Defense  of  Caracas  against  Plague, 
the  campaign  is  conducted  upon  the  following  basis:  1st.  Destruction  of 
rodents;  2d.  Early  diagnosis  of  the  disease  and  compulsory  declaration  of 
every  case;  3d.  Systematic  isolation  of  all  cases  in  a  special  station,  and,  4th, 
use  of  the  Haffkine  lymph  and  of  the  Yersin  serum.  The  systematic  and  vig- 
orous enforcement  of  these  measures  has  produced  satisfactory  results,  as  may 
be  seen  from  the  table  given  below,  which  comprises  from  April  18,  1908, 
when  the  epidemic  started,  until  this  date.  If  we  have  not  as  yet  succeeded  in 
eradicating  the  disease  entirely,  we  have  at  least  reduced  it  to  a  very  limited 
number  of  human  cases.  Indeed,  188  cases  during  41  in  a  population  of  nearly 
80,000  is  not  much  for  so  ravaging  a  disease  as  plague.  It  is  venturing  to 
assume  that  very  soon  plague  will  have  disappeared  from  Caracas,  just  as  it 
did  from  La  Guaira,  where  it  has  not  occurred  during  the  last  three  years, 
neither  in  man  nor  in  rodents.  In  making  this  assertion  we  base  it  upon  the 
fact  that  the  disease  in  rodents  has  decreased  from  0.66  per  cent  in  1909  to 
0.32  in  1911.  The  destruction  of  rats  in  Caracas  is  rather  difficult  on  account 
of  the  topography  of  the  land. 

The  table  referred  to,  showing  the  number  of  plague  cases  in  Caracas,  is 
as  follows : 

YEAR.  CASES. 

1908 78 

1909 29 

1910 39 

1911 42 

188 

B.   Measures  against  Yellow  Fever. 

Yellow  fever  is  an  endemic  disease  in  Venezuela,  one  territory  being  within 
the  yellow  fever  zone.  The  stegomya  callopus  is  one  of  the  commonest  insects 
in  our  cities.  Several  learned  Venezuelan  physicians  have  made  important 
clinical  investigations  on  the  subject,  and  the  First  Venezuelan  Medical  Con- 
gress appointed  a  commission  to  study  the  Venezuelan  mosquito. 

In  the  early  part  of  1910  was  begun  systematically  the  campaign  against 
yellow  fever  in  Caracas,  and  in  the  beginning  of  1911  the  enforcement  of 
active  and  efficient  prophylactic  measures  was  started.  This  campaign  is  car- 
ried on  as  follows :  1st.  Compulsory  declaration  of  all  cases,  both  confined 
and  suspected;  2d.  Rigid  isolation  of  all  patients;  3d.  Systematic  destruction 
of  mosquitoes  and  their  larvae. 

These  prophylactic  measures  having  been  in  force  since  not  long  ago,  it  is  not 
possible  at  this  time  to  notice  the  results  of  the  campaign,  but,  as  the  methods 
adopted  in  Venezuela  are  copied  from  those  so  successfully  tested  in  Cuba, 
Mexico,  Brazil,  Panama,  etc.,  it  is  only  logical  that  we  should  expect  to 
achieve  the  same  satisfactory  results. 

During  1910,  15,968  houses  were  inspected  for  mosquitoes,  and  4,415  bottles 
of  petroleum   used  in  destroying  the  insects.    During  the  first  eight  months 


162  FIFTH  INTERNATIONAL  SANITARY  CONFERENCE. 

of  1911,  26,850  houses  have  been  inspected,  and  5,706  bottles  of  petroleum 
used.  During  the  same  months  6,129  deposits  were  found  with  mosquito  larvae, 
and  destroyed. 

The  cases  of  yellow  fever  reported  to  Bureau  of  Hygiene  during  1910  and 
1911  were  as  follows:  1910 — 122  cases  with  39  deaths,  or  a  death  rate  of 
32  per  cent;  1911  (January  to  August) — 100  cases  with  52  deaths,  or  a  death 
rate  of  50  per  cent. 

C.   Measures  against   Cholera. 

Our  Martime  Sanitary  Police  Regulations  prescribe  the  manner  in  which 
vessels  arriving  from  cholera-infected  localities  should  be  treated,  in  accordance 
with  the  provisions  of  the  Washington  Sanitary  Convention.  As  soon  as  it 
became  known  that  an  epidemic  broke  out  in  Italy,  instructions  were  given  to 
all  Health  Directors  at  the  various  ports  to  make  a  more  rigid  inspection  of  all 
vessels,  specially  those  coming  from  Mediterranean  ports.  No  suspected  ships 
have  been  allowed  to  enter  our  ports,  and  up  to  the  present  time  we  have 
not  had  one  single  case,  in  spite  of  our  considerable  traffic  with  Italy.  As  an 
additional  preventive  measures,  all  physicians  are  required  to  report  all  cases 
of  cholera  nostras  coming  under  their  observation,  and  a  careful  investigation 
is  made  of  every  case  thus  reported. 

VII.  What  constitutes  immunity  from  yellow  fever. 

Although  in  reality  it  has  been  scientifically  and  definitely  established  what 
constitutes  immunity  from  yellow  fever,  or  when  should  a  person  be  considered 
as  immune,  it  seems  logical  and  natural  to  establish — even  though  temporarily — 
that  besides  those  who  have  suffered  an  attack,  also  those  who  have  lived  in 
an  infected  locality  for  a  long  time  without  contracting  the  disease,  may  be 
considered  as  immune.  As  regards  individuals  born  in  an  infected  locality  it 
is  to  be  supposed  that  immunity  is  so  easily  acquired  in  youth. 

VIII.  Prophylaxis    of    trachoma,    leprosy,    scleroma,    venereal    diseases, 

SMALL-POX,  TUBERCULOSIS,  AND  MALARIA. — LEGISLATION  AGAINST  THESE  DISEASES 
AND  RESULTS   ACHIEVED. 

Trachoma. — This  is  a  disease  which  is  very  seldom  noticed  in  Venezuela,  and 
the  health  authorities  at  the  ports  are  very  careful  in  the  examination  of  persons 
arriving  at  the  Republic,  never  allowing  the  introduction  of  any  person  suffer- 
ing from  the  disease. 

Leprosy. — There  are  in  Venezuela  two  leper  asylums,  one  in  Cabo  Blanco, 
in  the  Federal  District,  with  a  colony  of  300  lepers,  and  another  in  Providencia 
Island,  State  of  Zulia,  with  500  lepers.  In  Venezuela,  the  denunciation  and 
isolation  of  all  cases  of  leprosy  is  compulsory.  Recently  we  have  been  experi- 
menting with  "Nastin,"  but  we  are  as  yet  unable  to  report  upon  the  qualities  of 
this  new  remedy. 

Venereal  Diseases. — We  have  no  special  legislation  on  the  prophylaxis  of 
venereal  diseases.  Prostitution  is  not  regulated,  but  the  Police  Department  does 
not  permit  the  public  practice  of  the  profession,  and  regulates  the  system  of 
passive  tolerance.  The  women  devoted  to  the  profession  do  so  clandestinely. 
In  our  principal  hospital  we  have  a  department  of  syphilis  and  dermatology. 
There  are  also  special  clinics  of  ginecology  and  diseases  of  genital  organs. 

Small-pox. — Thanks  to  compulsory  vaccination  and  re-vaccination,  Venezuela 
is  almost  free  from  this  disease;  only  once  in  a  long  while  some  sporadic  case 
occurs. 

Tuberculosis. — The  white  plague  continues  to  occupy  a  high  place  in  our 
mortality  statistics.  In  the  Hospital  Vargas  of  Caracas,  special  wards  have  been 
established  for  the  proper  isolation  and  treatment  of  consumptives.  There  is 
in  the  capital  a  private  association  called  the  Anti-Tuberculosis  League  which 
renders  most  valuable  aid  through  its  dispensary,  distributing  freely  among  the 
poor  all  necessary  medicines  and  means,  and  holding  periodical  public  lectures  to 
educate  the  masses. 

There  is  now  under  consideration  the  establishment  of  a  private  tuberculosis 
sanatorium  in  the  outskirts  of  Caracas. 


FIFTH  INTERNATIONAL  SANITARY  CONFERENCE.  163 

Besides  a  special  propaganda  against  the  disease,  there  are  enforced  certain 
measures  of  disinfection  and  sanitation  of  public  buildings,  theaters,  schools, 
barracks,  and  private  houses   which  may  be  infected. 

By  decree  of  October  26,  1910,  the  following  articles  are  allowed  free  of  cus- 
tom duties : 

Calcium  carbide,  creoline,  sulphur,  formol,  sulphate  of  iron,  sulphate  of  copper, 
Tersin's  serum,  Haffkine's  lymph,  disinfecting  apparatus  of  all  kinds,  cultures, 
so-called  "kill  rats"  and  "rat  plague." 

Malaria. — The  prophylaxis  of  malaria  is,  in  the  opinion  of  the  Venezuelan 
Delegation,  the  most  important  problem  affecting  the  welfare  of  the  inter- 
tropical countries  of  the  Western  Hemisphere.  We  therefore  take  the  liberty 
to  call  the  special  attention  of  the  Conference  to  this  subject. 

In  the  work  of  general  sanitation  of  the  tropical  countries  of  America, 
malaria  must  necessarily  occupy  a  prominent  place,  because  that  tenacious 
malady,  the  most  formidable  endemic  of  our  zone,  is  the  worst  and  most  power- 
ful enemy  of  the  progress  of  our  countries.  In  Venezuela,  for  instance,  malaria 
kills  every  year  from  8,000  to  10,000  inhabitants  of  all  ages. 

Since  the  Fourth  Sanitary  Conference,  there  was  held  in  Simla,  British  India, 
in  October,  1910,  a  special  conference  for  the  study  of  malaria  and  its  prophylaxis. 
That  meeting  passed  resolutions  of  inestimable  value  for  the  defense  against 
malaria.  These  conclusions  we  beg  to  recommend  this  Conference  to  adopt,  as 
constituting  a  code  for  the  defense  against  malaria. 

IX.  Monthly  and  yearly  statistics  on  mortality  and  morbility  in  the 

PRINCIPAL    PORTS    AND    CITIES.    AND    REPORT    UPON    THE    ADOPTION    OF    THE   BERTILLON 
NOMENCLATURE. 

Since  all  along  the  Venezuelan  coast,  malaria  and  dysentery  still  prevail 
endemically,  our  mortality  and  morbility  are  quite  high.  The  death  rate  is 
represented  thus:  La  Guaira,  33  per  1,000;  Puerto  Cabello,  42  per  1,000; 
Maracaibo,  36  per  1,000;  Cuidad  Bolivar,  23  per  1,000;  Carupano,  25  per  1,000. 

Bertillon  Nomenclature. — This  nomenclature  has  been  in  force  in  Venezuela 
since  the  time  when  we  undertook  the  systematic  study  of  demographic  statistics. 
Recently,  the  Government  revised  its  blanks  in  accordance  with  the  amendments 
introduced  in  1909  and  with  the  New  Abridged  International  Nomenclature; 
but  further  increasing  it  in  order  to  insert  items  which  are  indispensable  in  the 
tropical  countries. 

Death  certificates. — By  decree  of  March  31,  1911,  the  Federal  Government  has 
provided  that  the  death  certificates  shall  be  uniform  throughout  the  Republic, 
and  made  upon  blanks  printed  and  furnished  by  the  Government.  In  this 
certificate  is  entered  the  immediate  cause  of  death,  the  principal  disease,  and  the 
number  belonging  to  it.  To  facilitate  this,  the  nomenclature  is  reproduced  at 
the  back  of  the  blank. 

X.  Sanitary  inspection  of  international  traffic,  both  by  land  and  sea,  in 

CASES   OF   QUARANTINE   INFECTIOUS   DISEASES. 

With  regard  to  the  sanitary  inspection  of  international  trade,  we  are  governed 
since  1909  by  the  provisions  of  the  Maritime  Sanitary  Police  Regulations,  drawn 
in  conformity  with  the  needs  and  resources  of  the  Republic,  but  based  upon  the 
stipulations  of  the  Washington  Convention. 

XI.  Sanitary  laws  on  immigration. 

As  the  immigration  into  Venezuela  is  still  very  small,  we  have  no  special 
legislation  on  the  subject.  At  present  we  confine  ourselves  to  a  careful  exam- 
ination of  all  passengers  arriving  from  abroad,  rejecting  those  that  may  be 
suffering  of  any  infectious  disease. 

XII.  Adoption  of  sanitary  documents  approved  by  the  fourth  conference. 

We  consider  that  the  forms  of  bill  of  health  approved  by  the  Fourth  Confer- 
ence, being  useful  for  their  purpose,  should  be  adopted  by  all  countries  of  the 
Continent,  thus  attaining  a  much  desired  uniformity. 


COLUMBIA  UNIVERSITY  LIBRARIES 

This    book    is    due    on    the    date    indicated    below,    or    at    the 
expiration   of   a   definite   period    after   the  date  of  borrowing,   as 
provided    by    the    library    rules    or    by    special    arrangement    with 
the  Librarian  in  charge. 

DATE    BORROWED 

DATE    DUE 

DATE    BORROWED 

DATE    DUE 

C28(955)100MEE 

P19 

1911 
pan  American  Sanitary  Conference, 
5,  Santiago  de  Chile,  1911. 

Transactions. 


